Promoting Health policy and system Research in Developing countries

EVs in Beijing 

It is of no doubt that not only the number of health policy and systems researchers in developing countries that is low, but also the challenges these researchers face in terms of necessary infrastructure to enable them conduct state of the art research independently .The Emerging Voice for Global Health (EVGH) initative of the Institute of Tropical Medicine might probably shade light to addressing the aforementioned issues in developing countries. Allison Stevens, from the Consortium for Health Policy and Systems Analysis in Africa (CHEPSAA) provides a detailed account on the potentials of EVGH in impacting health policy and systems research in developing countries. EVGH initiative is viewed as a platform for young researchers, which encourages them to have their voice heard through presenting research in conference formats and getting intensive skills training as well as content training in methodology. EV4GH brings together 50 young health policy and system researchers, from low and middle income countries and this year, it was Beijing that was the chosen meeting point during the 2nd Global symposium for Health systems research.

Malaria candidate vaccine reduces Malaria by approximately one third

http://static.ibnlive.in.com/ibnlive/pix/sitepix/10_2011/malaria_1910.jpg

The multicounty malaria vaccine trial that included 6537 children aged between 6 to 12 weeks has proved to be protective only for about 30% .These findings came as a dissapointment because this study was one of the most promising large scale phase III vaccine trial.

The RTS, S malaria candidate vaccine that was expected to protect African children from malaria has shown an unacceptably low protection level. However, the investigators found that, in addition the vaccine reduces episodes of severe Malaria among infants for about 26% up to 14 months after the babies immunised.

The results of this trial were presented at the International African Vaccinology conference in South Africa and simultaneously the New England journal of Medicine (NEJM) published the results.

Dr.Salim Abdulla one of the investigators from Ifakara Health Institute in Tanzania  said that  "and we should may be thinking of first generation vaccine that is targeted only for certain children".

On the other hand, Blaise Genton from Swiss Tropical and Public Health Institute in Basel, Switzerland that the vaccine might work better at some trial sites than the average reported today.

Despite these results, many scientists acknowledged that this trial has a greater contribution to the science of Malaria Vaccine; also the intensive cooperation of African research centres towards working successfully in this trial was congulatulated. However WHO could not commend anything on these results because the study is yet to be finalised.The study is scheduled to be completed in 2014.

Some insights from the Beijing Symposium on HSR

http://www.who.int/alliance-hpsr/whostrategyhpsr/en/index.html

The Symposium on Health system research was concluded on 3rd November this year.Remarkable progress has been noted interms  of form, content and organisation.The first global  Strategy on  Health policy and system research was announced by WHO.The strategy has three major aims; unifying the world of research and decision making in connection to various displines of research to strengthen health systems. It also aims at contributing to the broader understanding of this field by clarifying the scope of Health policy and systems research.In addition, this strategy is envesieged to serve as an agent for change and calls for more prominent role for Health policy and systems research especially this time when the focus is towards a broader goal of Universal health coverage.
"Inclusion of inovations towards Universal health coverage " was the overall theme of the conference; says Kristof DeCoster when giving his  reflections on the symposium  in the IHP blog. He also points out on the impact health system researchers and the public health community have on power and politicians at country level to the grassroots.
The Beijing statement higlights the concluding statement of the conference and provides the prospects for the 2014 3rd Global symposium on Health systems research.

2nd Global symposium on Health system Research

The second Global symposium on health system research is scheduled to start tomorrow in Beijing. It is impressive to see that everything and everybody (plenary speakers and participants) is ready.The symposium is dedicated to evaluate progress, sharing insights and recalibrating the agenda of science to accelerate universal health coverage (UHC).
In this symposium , participants will share new state-of-the art evidence on universal health coverage, review the progress towards UHC including progress since the World Healt report of 2010, facilitate greater collaboration and learning communities across desplines, sectors, initiatives and countries. It will also identify and discuss the approaches to strengthern the scientific rigor of health systems research including concepts, frameworks , measures and methods.

The main themes of the conference will be; knowlege translation, state-of-the art research on Health Systems Research (HSR)  and HSR methodologies.Cross-cutting themes include; Innovations in HSR, neglected priorities or population groups in HSR and financing and capacity building for HSR.Moreover the new international society called Health systems global will be officially launched. As in the 1st global symposium on HSR that took place in 2010 in Montreux, Swirtzeland, the emerging voices will actively participate in the symposium. 

Fake ARVs in Tanzania: Consumers at a crossroads

Counterfeit drugs around the World

It is well known that fake drugs cost a lot of lives in developing countries, where it is a home of most of fake drugs. This has been a serious challenge to the integrity of public health systems as well as serious threat to the national security in these countries and probably is a major cause of death (from curable diseases) than anything else.

Of recent, in Tanzania, the Minister of Health and social Welfare , Dr. Hussein Mwinyi  suspended top officials of the Medical sores department (MSD) and halted the production of all drugs by TPI ( alleged to have manufactured fake ARVs) to allow investigation to take place. He also urged all people under medication to continue using ARVs drugs because they are safe as the fake ones have already been removed from the hospitals.

It is by now a public knowledge that most of the drugs produced locally are of low quality due to the widespread corruption in political circles in the country. Also, the fact that global counterfeit black market thrives better in poor countries, makes Tanzania vulnerable in all aspects. The profits from this “crime” are being co-opted by an array of organised criminal groups, who see that this the only way they can survive.

Although the Minister of Health and social welfare has assured the public that the drugs that are in the market today are of good quality, critics can still think that the MSD officials who were suspended are the ones who know exactly what the public is consuming. Earlier this year I posted an article on  fake malaria drugs circulating in the country. The issue here is; who exactly knows the network behind these fake drugs in the country? How can we make our medicines safe? What about the patients who have consumed these fake drugs? The first question might probably be answered by the committee formed by the Minister. I am not sure about the remaining questions!

It has been always said (at least by most policy makers) that having appropriate policies and adequate power to reinforce the policies is the only way to control these crimes. This might be true at least in theory. Corruption has made the aforementioned statement useless because people who are supposed to make (guide the formulation of) such policies and reinforce are the ones who are involved in these criminal networks. I think, it is a time now for the consumers (the victims) to do something rather than waiting for committees or flawed expert reports. Here you are talking of about 500,000 Tanzanians  who are on Antiretroviral therapy

Public-Private Partnerships in health care: Any prospects for equity?

"We are living in an unfair world, and that gonna not change whether you like or not"!..This was an opening statement by  one of the speakers in a conference on  "the role of Public Private Partnerships (PPP) in equity in health care". He was representing a Multinational corporation that has signed more that 200 PPPs in the world, especially in developing countries, where because of poverty, governments find themselves signing such PPPs in order that they can at least provide social services to their people. The company having been working in health care technologies, have facilitated building up to date health care facilities and supplied up to date medical equipment to these countries. The fact that they have technologies and are looking for profits, it is without doubt that they will not provide services to the people without profit. At the time when these deals are signed and implemented, no one can clearly see  that" this as a profit making business" as the recipient governments and the citizens look at what they get at that time, but they don't attribute to what is  going to happen later. The dark side of these partnerships is making the governments or the people dependent to the technologies brought by a partnering company ,in which afterwards, you might find these technologies to be very expensive. These deals have contributed to increased inequalities and poverty in most of the developing countries. It has become at least difficult talking about Social justice when these companies are involved in PPPs
The Private sector ( especially the Multinational corporations and Foundations) is becoming more powerful than governments in developing countries, they take advantage of corrupt governments to sign PPPs that are not advantageous to these countries, but to themselves and the countries they represent.
As a point of departure from imaginary world, he pointed out of the fact that we can not eliminate inequalities in this world, what we can do is just to reduce it by few kilometers.
Public-Private Partneships can take different forms, and sometimes it is difficult  even to know how does a Private sector differ from a public one.
However, this was an example of the Private for profit Multinational companies, that might not represent all what is done by the Private sector in eliminating inequalities in the health sector. The private sector in the health sector  in many developing countries is composed of  Non-for profit foundations, Faith based organisations, Private for profit institutions and Private practitioners (who on part time basis work in Private clinics/ hospitals). Through the Non-for profit and Faith based organisations, alot have been done in eliminating inequalities in the health sector. Different innovations have been encouraged to increase access to health care services even to hard to reach areas. The fact that the role of the government is to provide services its citizens, non-for profit and religious organisations share this goal; therefore this partnership is a partnership that has the same goal, unlike the private for profit multinational corporations.
Should governments in developing countries opt out partnering with profit making multinational corporations  in order to provide equitable social service?

One year anniversary of the Occupy movement: A view from the Global South

The Occupy Movement celebrated its first year anniversary on 17 September this year.  The Movement is believed to stem from the Arab spring, spreading through Spain and Greece to the US. The Arab spring was relatively successful in Tunisia, Egypt and Libya but some other countries in the region such as Syria are still a mess, unfortunately. In the 2011-2012 Spanish protests, also known as 15-M (15 May movement), so called ‘Indignados’ held a series of demonstrations in more than 58 cities demanding radical change in Spanish politics as politicians systematically seem to condone mass unemployment, welfare cuts, brutal neoliberal policy measures and the dominant influence of financial institutions.

The Occupy movement aims at addressing the enormous social economic inequalities that exist in the world today. The initiators of the movement used the slogan “We are the 99%” (i.e. the ‘have nots’). They blame the 1% (the ‘haves’) who control the economy. In New York City, they demonstrated by occupying Wall Street (OWS) pointing out the greed, corrupt deals and excessive influence of corporations on the government, particularly in the financial sector.

Aiming at turning the pyramid upside down, the Occupy movement questions our modern capitalistic societies that in the name of liberalism, democracy (what if democracy is turns out to be an illusion?) and other fancy political economy models ( such as conditional aid and poverty reduction programs by the World Bank) perpetuate socio-economic systems that are fundamentally unjust and in fact often even worsen inequalities in the society. These ‘clever’ models have more in common with plutocracy (whereby an oligarchy of extremely wealthy individuals control the country) rather than with democracy (all people have a say in decisions affecting their lives). Labels as ‘state corporate capitalism’ or a fusion of big capital and the government describe the governance system better than the more politically correct word ‘democracy’, it seems. Nevertheless, although the Occupy movement has spread to many cities across the western world, it is fairly unpopular in the global south.

The unpopularity of this movement in the developing world, especially in Sub-Saharan African countries (SSA), might be attributed to several reasons. The access to social networks (via the internet) that has been a key ingredient of success stories in other parts of the world is still limited in SSA. Moreover, (local) civil society organisations have limited capacities when it comes to mobilising people so as to address social concerns. As for international organisations and agencies, they tend to have their own agenda and might prefer to distance themselves from movements that might trigger uprisings. Furthermore, most of the African governments intimidate people involved in demonstrations; by now these governments are even more alert because of the ugly Arab spring “aftermath” in a number of countries in the Middle East. Also, due to the fact that the majority of the people in these countries are in rural areas, it is easier for governments to limit access to the (at least sometimes) enlightening mainstream media. In addition, history has formed another barrier to these movements, as many countries gained their independence by war. Therefore any group that emerges to initiate such movement might be perceived as a rebel group, rightly or wrongly. There exists no record of successful people’s based movements that managed to change political and economic systems in the past 50 years of independence of most SSA countries.

Admittedly, there have been some Occupy Movements in South Africa. I believe this might be due to the fact that this country’s political economy and background differs from most of the African countries. Countries like Nigeria and Senegal also witnessed Occupy-like movements after fuel subsidy removal and the denouncing of incumbent President Abdoulaye Wade and his decision to run for a third term respectively. Hopefully, with increased globalisation these movements might spread to more countries. Today we witness harsh neoliberal policies in many SSA countries, coupled with the enormous influence of multinational corporations and rampant corruption in African governments. Consequently, the gap between the rich and the poor will probably increase further, which might inspire new Occupy branches. It is also evident that the recent growth figures in African countries have not benefited the majority so far. Combine this with the enlightenment  and rising expectations that tend to come with globalisation, and we might soon see more Occupy (style) movements pop up in many countries .The austerity measures taken in compliance to neoliberal ‘dictates’  ( meant to perpetuate capitalism?) that create  unemployment, open market economies and inflation while cutting government spending  on essential services such as education, health, transport and other essential services that empower and upgrade the living standards of the people, might justify the cause.

Since the Occupy movements are taking different shapes in different settings – from the Arab spring to a diversity of Occupy movements and actions in many cities in the world -, you could also ponder what an Occupy movement means in a country like Tanzania. What I consider an Occupy movement in Tanzania, for example, are the daily strikes among public sector employees (doctors, teachers and other civil servants) and the pro-activeness and courage of many citizens in supporting opposition political parties. In neighbouring countries similar animosities have led to tribal skirmishes, even in the struggle (for example, by Kenyan doctors) for the limited portion which has spilled over to them from the “Big Fish” (the 1%). Little by little, humiliated enlightened youths are developing a rebellious spirit as they are not very pleased with the ‘happy few’ who are unashamedly enriching themselves.

Due to the fact that the right to demonstration and petition is not explicit in the most of the African countries (including Tanzania), in many instances human rights of individuals who support or who are in the frontline of such movements were violated. The recent kidnapping of the coordinator of the doctors’ strike and killing of a journalist by the police on political grounds in Tanzania, point to the fact that many people are in fact supporting the Occupy Movement, but in a different way, a hard way so to speak, as the government is working hard to suppress them by intimidation and often violating their human rights using the police –  in many African countries, the police is like a private organisation that works for the 1%. The use of the police as a silencing tool of late is not only igniting the rage of more potential Occupy Movement members but to some extent even worsening the situation. However, the SSA Occupy movements are not going all the way like the Arab spring movements (who ran similar risks of intimidation, torture and all types of violation of human rights) due to the fact that there is some practice of democracy in most SSA countries. Therefore people might be pleaded to wait for elections where they might elect a leader they like (although this is always tricky due to often massive vote rigging).

In cities where the movement has spread, people have taken to the streets. However, different proponents of the movement have been using different names (that they feel comfortable with) such as Occupy money, Occupy economy and many more. It casts some doubt on whether the proponents have similar demands as the original Occupy Wall Street movement. One year later, in order to gain momentum again, some Germans even suggest a global Occupy brand or NGO that would work to address these issues worldwide. Critics, however, view Occupy Wall Street as just another unorganised ‘feel good’ movement where people demonstrate, discuss their concerns and attract attention… and that’s it. I think that is being oversimplistic, though. Let the supporters cherish the success of the Occupy Movements so far!

The movement might mean different things to different people, but the Occupy movements do have one thing in common: they all point out the vast inequalities that exist in our 21^st century world and are perpetuated by financial institutions. The movement emphasizes it’s urgent to do something to liberate the majority of the people who are left without reliable social services, while the happy few (the financial elites) are enjoying their lives big time. In principle, doing away with capitalism (individualism?) calls for a form of collectivism or socialism, but these ideologies seem to have failed as well in the past. Will the Occupy movement come up with another idea? I do not know. However, there is hope that the movements might form a catalyst to other movements that advocate for social justice such as the People’s Health movement, and will help propel Universal health coverage, as without them, UHC could very well remain elusive in our übercapitalist world.

This article is also available at International health policies (IHP) blog as a guest editorial