IHSJ Reader, July 1, 2011

IHSJ Reader     July 2011     Issue 4          

Note: Triple asterisk (***) indicates subscription-only sources.

HAITI

Has Aid Changed?: Channeling Assistance to Haiti Before and After the Earthquake (Office of the Special Envoy for Haiti, June 23, 2011)
The Office of the Special Envoy for Haiti (OSE) released a comprehensive report analyzing aid effectiveness in Haiti before and after the earthquake. Although aid to Haiti tripled in 2010, data suggests that aid recipients and modalities have not changed: resources continue to bypass Haitian public institutions, Haitian businesses and Haitian NGOs. For example, of the total amount of relief aid dispersed in the first few months after the 2010 earthquake, a mere 1% was received by the government. Recovery aid was better distributed, with a confirmed 12% going directly to the Government of Haiti. It is time international donors demonstrate their commitment to just and sustainable development in Haiti by: (1) channeling resources directly to Haitian public institutions and ministerial budgets; (2) increasing local hiring and procurement; and (3) working within the auspices of the national Action Plan and other Haitian-led plans. Guided by aid effectiveness and human rights principles, Partners In Health is dedicated to accompanying the Haitian public sector in  rebuilding and strengthening the health system.

HEALTH SYSTEM STRENGTHENING

Maternal Death Stalks Malawi’s Rural Poor (GlobalPost, John Donnelly, June 26, 2011)
In Malawi, where 82% of the population lives in rural communities, strained relationships between donors and the Government of Malawi could have a drastic impact on impoverished communities. (Most notably, the U.K. Department for International Development--formerly Malawi’s largest funder--decided to cut aid to Malawi in March of 2011.) As in most rural poor communities, health worker shortages and the lack of access to primary health care services prevent women from getting the care they need. Training and paying village health workers to connect women to family planning services, pre-and post-natal care, a safe place to deliver, and access to emergency surgery during complicated deliveries will help reduce maternal mortality among poor women. In this article, John Donnelly recounts the death of Alola, one of an estimated 3,000 Malawian women who could be saved each year if comprehensive health care existed at the community, clinic, and hospital level.

The State of the World’s Midwifery (UNFPA report, June 2011)
The United Nations Population Fund (UNFPA) released a collaborative report that focuses on strengthening the role of midwives in the 58 countries where 91% of maternal deaths occur. Every year, more than 350,000 women die while pregnant or giving birth, up to 2 million newborns die within the first 24 hours of life, and there are 2.6 million stillbirths. Nearly all of these deaths could be prevented if women had access to quality health care before, during and after pregnancies. When midwives are integrated into communities, adequately trained, focused on quality care, and located in health systems where they can refer complicated pregnancies and deliveries, midwives can help eliminate maternal and newborn deaths and prevent stillbirths. Midwives play a critical role in delivering care in many of the health facilities which PIH supports around the world.

Green Shoots in the Killing Fields (Foreign Policy, Charles Kenny, June 20, 2011)
The Democratic Republic of the Congo (DRC) is mired in poverty, largely due to a violent history of tyranny and exploitation. World Bank data suggests that 71% of the population lives on less than $1 a day, up from 60% in 1990. Yet amidst the scourge of absolute poverty and poor governance, the prevalence of maternal mortality, child undernutrition and HIV/AIDS continues to fall. These critical improvements suggest that aid, when directed at the right to health for the poor, can be a powerful tool in the fight against disease and premature death. While aid alone cannot solve the crises of poverty and inequality, health outcomes in the DRC refute the argument that foreign aid should be withheld from impoverished, struggling states.

One Million Community Health Workers (The Earth Institute, Columbia University, June 1, 2011)
As members of the communities in which they work, community health workers (CHWs) provide vital access to health care for the rural poor who live in places with weak primary health care systems. This report focuses on the necessary steps and infrastructure developments to create a reliable system of CHWs and calls for one million community health workers to be hired and trained in sub-Saharan Africa by 2015. Many governments and organizations expect CHWs to deliver essential health services on a voluntary basis. However, PIH and other partners including the Earth Institute argue that paying CHWs is a moral and economic imperative.  Scaling up CHW training, deployment, and compensation while providing strong supervision and linkages to health centers is central to achieving the Millennium Development Goals (MDGs). 

HIV/AIDS

AIDS: Let Science Inform Policy (SCIENCE, Anthony S. Fauci, July 1, 2011)
Anthony Fauci argues that thirty years after the first reported cases of AIDS, ample evidence-based tools exist to end the AIDS pandemic. "For the first time in the history of HIV/AIDS, controlling and ending the pandemic are feasible; however, a truly global commitment, including investments by those rich and middle-income countries whose contributions have thus far been limited, is essential."  UN Member states recently agreed to double the number of people on life-saving antiretroviral therapy in low and middle-income countries by 2015 and halve the number of TB-related deaths among people with HIV. Instead of the current $16 billion, an estimated $22-23 billion will be needed by 2015 to end one of the most devastating public health crises of our time.

NON-COMMUNICABLE DISEASES

Prevention and Control of Non-Communicable Diseases (UN General Assembly, Report of the Secretary-General, May 19, 2011)
The international community has focused on rolling back the tide of communicable diseases such as HIV/AIDS, tuberculosis, and malaria in poor countries, yet the epidemic of non-communicable diseases (NCDs) remains neglected.  Poor outcomes from NCDs such as cancer, mental disorders, cardiovascular disease, diabetes, and chronic respiratory disease disproportionately occur in impoverished populations with a full 80% of deaths from these conditions occurring in low- and middle-income countries. To address this gap, UN member states must commit to working with a broad range of stakeholders to make NCD prevention, diagnosis, treatment and palliative care available and affordable for the poorest populations.

MULTIMEDIA 

Slideshow of Foreign Transaction Tax Global Day of Action (Flickr, June 2011)
Activists in over 40 countries participated in a “global day of action” to encourage European leaders to back a Financial Transaction Tax (FTT) that could raise hundreds of billions to tackle poverty and climate change. From extravagant stunts to mass demonstrations, check out this Flickr slide show to get a sense of the global commitment to the FTT.

Interview with Gene Bukhman (Global Health TV, June 17, 2011).
Dr. Gene Bukhman, Director of the Program in Global Non-communicable Disease and Social Change at Harvard Medical School, discusses NCDs in the poorest countries. 

A New Paradigm for Global Health: Solidarity (TEDXRainier, Dr. Wendy Johnson, November 7, 2010)
In this compelling presentation, Dr. Wendy Johnson reveals how a model of “colonial humanitarianism” continues to define foreign aid.  Instead of creating a parallel track of disease-specific health interventions that fail to build local capacity, donors should work through the public sector to strengthen access to comprehensive health services.  Dr. Johnson argues that a paradigm shift is required to make foreign aid effective, from colonial-era charity to a model of solidarity.

Stay connected with the PIH Blog, Facebook, Twitter, and YouTube pagesMolly Franke, Megan Murray, and colleagues report that early cART reduces mortality among HIV-infected adults with tuberculosis and improves retention in care, regardless of CD4 count.