Blogs

Link Between AIDS and Maternal Mortality Requires Policy Change
New York, USA - April 14, 2010 A study funded by the Gates Foundation, released today in The Lancet and showing welcome progress on reducing maternal mortality globally, also reveals one catastrophic exception. The good news in "Maternal mortality for 181 countries, 1980 - 2008"[i] is that worldwide deaths related to reproduction fell by one-third over the period studied. But that is tempered by bad news emerging from southern and eastern Africa: in the region of the world most heavily affected by the AIDS pandemic, HIV has not only blocked progress toward maternal health, but is responsible for an additional 61,000 maternal deaths per year.

Some reactions to What We Hear (and do not hear) in many a public health conferences these days.
1. Am I tired of going to such conferences? Sort of.
2. It is just that, in them, we hear about so many things that need doing and have so long been overdue (…achieving the health MDGs, strengthening health delivery systems, organizing and empowering beneficiaries to demand changes ….and on-and-on…). One gets the impression that it is in times of crisis that we finally will bring to the fore what really needs doing and has long been overdue… But not even in such circumstance does the needed happen in our meetings of the learned; almost nothing substantial, beyond a passing comment, is heard about taking actions to address the ‘condition of poverty’, about disparity reduction, about addressing the widespread and numerous violations of the human right to health and to nutrition; nothing substantial and really deep-felt is heard about empowering claim holders –or worse: the concept of empowerment is repeatedly hijacked by making it mean giving women greater self-esteem, providing them with health education and nutritional knowledge and skills and/or ‘empowering’ them to better take care of their children.
3. Empowering claim holders a) to exert growing social counter-power to the power that keeps them in poverty; b) to fight the often flagrant health and nutrition rights violations they are subjected to; and c) to fight for greater equity and access to the services they need, all still seems to be a taboo topic at the conferences I attend. A shame.

With large donor projects winding up and little bilateral support for HIV programmes in the Democratic Republic of Congo (DRC), the country is facing the possibility of ARV shortages and rising HIV mortality, say aid workers. The World Bank's Multi-Country HIV/AIDS Programme (MAP) is in the last 10 months of its six-year run in the DRC. The US President's Emergency Plan for AIDS Relief, PEPFAR, which has been providing medication for opportunistic infections and laboratory support, is expected to halt this aid, while the international funding mechanism, UNITAID, which has been providing second-line medication and paediatric ARVs, is withdrawing in 2011. That leaves the Global Fund to fight AIDS, Tuberculosis and Malaria as the only donor for HIV treatment in the country.

LONDON (Reuters) – Donor money for health care in developing countries could be spent more effectively if it were channeled through a single global fund, experts said Friday. A steady flow of funds is essential for health sector improvements, Gorik Ooms from Belgium's Institute of Tropical Medicine said. Research by Ooms and other experts published in The Lancet medical journal Friday said the amount and regularity of international aid was often unpredictable, making it hard for governments to plan ahead. Another study, by Harvard Medical School and the University of Washington, found that in some recipient countries, mainly in sub-Saharan Africa, foreign health aid was partly replacing -- not supplementing -- domestic health budgets. In such countries, for every $1 given in aid, governments move between 43 cents and $1.14 of their own health funds to other sectors, such as education or sanitation.

Kathmandu is the most polluted city in Asia with respect to air quality. Every year, around 2,000 people die in Kathmandu because of carbon pollution related diseases; and the daily impact of carbon pollution on the population is massive. It affects all irrespective of gender, age, profession, social-economic status, political beliefs or religion. We all know how ugly our city is, but we are behaving as if we are not affected by it. The city has become a victim of political absurdity and intellectual delusion of its residents that undermines the daily needs of the population, and most importantly, our rights to healthy breathing. In such a city, we cannot imagine a healthy and prosperous life without changing its environment. We cannot ignore our health. Urban health matters to us.

Every year the WHO observes World Health Day on the 7th of April, and each has a theme. World Health Day 2010 will focus on urbanization and health. The WHO is encouraging people to "Be part of a global movement to make cities healthier". Sounds good.
The new WHO 'social-networking' website states that "With the campaign "1000 cities-1000 lives", events will be organized worldwide calling on cities to open up streets for health activities. Stories of urban health champions will be gathered to illustrate what people are doing to improve health in their cities". Looks good.
But after looking at this invitation encouraging me to be part of a global movement, I opened an e-mail from Dr. Reed, Director of Health Action International (HAI) with an open-letter to Dr. Margaret Chan, DG of WHO. It calls upon Dr. Chan to reverse a recent decision to not allow NGO Briefings (side-events) that were to be held during the World Health Assembly in May.

I'll not observe, celebrate or mark World Health Day until all the world can enjoy their right to health, as clearly stated in the WHO Constitution:
"The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without the distinction of race, religion, political belief, economic or social condition. / The right to health means that governments must generate conditions in which everyone can be as healthy as possible. Such conditions range from ensuring availability of health services, healthy and safe working conditions, adequate housing and nutritious food."
When WHO and its Members (192 governments) fulfill their responsibilities and the right to health is enjoyed by all, then I will celebrate World Health Day. Enjoyment must be equitable first.

World Health Day? Is that the day when maybe 3 billion poor people in need can have access to some medical treatment, or a good meal, or clean water? A special day for the health of the world — when everyone has the possibility to get better, feel better and do better on a global scale — is that what they mean by World Health Day? No, I don't think that is World Health Day. It's probably just another day for the 3 billion, just another 24 hours of struggling to stay alive and able to continue to scratch-out an existence. Very very few will even know that the UN has said it's a special day. Over these 24 hours, tens of thousands will die, with the 'cause of death' being from curable or manageable diseases, or fixable problems related to poverty. So, what's so special about World Health Day? / linda.nsembu at yahoo.co.uk

FYI: New research suggests that the poor knowledge and attitudes of doctors and healthcare workers in South Africa are limiting access to preventative tuberculosis (TB) therapy. The qualitative study by the health research non-profit, the Aurum Institute, found that many doctors and health workers shied away from prescribing isoniazid preventative therapy (IPT), in which daily doses of the antibiotic isoniazid are administered for at least six months to reduce TB risk in HIV-positive people. The reasons most often cited by health professionals for not prescribing IPT included an inability to rule out active TB, little knowledge about IPT's benefits, and little confidence that patients would continue taking the medicine, said Dr Salome Charalambous, HIV/AIDS Programme Director at Aurum, who presented the research at the institute's annual symposium for health workers in Johannesburg.

Jeff Sachs recently published a blog post in the Guardian calling for changing the mandate of the Global Fund from AIDS, TB and malaria to health generally.  It’s a great idea. But in truth, the Global Fund is already doing a lot to fund health systems. At least 30 percent of the Global Fund’s funding in rounds one through seven were focused on health systems inputs. In rounds 8 and 9 the Global Fund made its commitment to providing funding for strengthening health systems much more explicit and encouraged countries to submit cross-cutting health systems strengthening proposals.  The Global Fund is already funding: training and paying health care workers, strengthening laboratory capacity, upgrading infrastructure, strengthening procurement and supply chain management systems, improving monitoring and evaluation, and even strengthening health insurance systems, to name just a few key areas.  While this funding must be related to improved outcomes for the three diseases, spending on health systems has never been restricted to just fighting the three diseases (although some countries may have planned and implemented programming in that way).