Sharing knowhow and joining forces towards Health for All

MMI Network News, November 2010

WHR 2010
WHR 2010

Editorial: Universal health coverage and its caveats

Dear reader,

Last month I attended two international meetings. In Nairobi, the African platform on human resources for health (1) discussed the health workforce shortage in Africa and how international donors and initiatives can strengthen existing national strategies to overcome it. And in Montreux, Switzerland, the Global Forum on Health Systems Research (2) addressed the capacity of research to improve health systems outcomes in order to attain universal health coverage.

There is some shift in health systems thinking, both for the good and the bad. Let me start with the good one: More than 60 years after the adoption of the WHO constitution and more than 30 years after the Alma Ata declaration the right to health as an entitlement that every human on this planet has is back on the political stage. Universal health coverage has become an issue – and the topic of this year’s World Health Report (3). 

Recently, a “joint action and learning initiative on national and global responsibilities for health” has been initiated (4). It wants to research and provide action on the following key questions: 

  • What are the essential services and goods guaranteed to every human being under the human right to health?
  • What is the responsibility that all states have for the health of their own populations?
  • What is the responsibility of all countries to ensure the health of the world’s population?
  • What kind of global health governance is needed to ensure that all states live up to their mutual responsibilities?

Basically the initiative breaks away from the concept that health care is a matter of self-determination and autonomy of states and that international assistance should only temporarily support countries financially to overcome the health problems they face. From a rights-based perspective there is mutual obligation and dependence between the international community and states to guarantee universal health coverage. On the other hand, well functioning health systems should not only provide people with qualitative care for better health outcomes, but should also protect them against catastrophic health-care expenditures. This idea is further explained in a background paper of the forum on health systems research (5). It describes the difference between national universal health coverage (a state obligation) and global universal health coverage (including international responsibilities). The authors promote consorted global health action as health is a global public good. The public good concept, like the human security concept, emphasises that consorted global action can contribute to international political stability as communicable diseases containment, national social cohesion, economic growth and reduced population growth benefit from this action.

There are other voices, too. Francis Omaswa, coordinator of the African centre for global health and social transformation (ACHEST), poses critical questions about the ‘globalisation’ of the health debate. According to him three sets of actors are necessary to improve health and country ownership in Africa: African governments should take up their responsibilities as they committed themselves to several international health declarations; civil society in Africa must become stronger to hold their governments accountable for their right obligations on health; although some of the international community supports country ownership, others still see African counterparts as enclaves to extend their own missions and are very patronising. (6)

What intrigues me during these international health gatherings is the big difference between the health reality in so many places in the world versus the bubbles in which the global health elites reside and talk about equity, universal coverage and strengthening systems for the poor. After the workshops and seminars that offer discussion on how to move forward the state of the health in the world, the donors, policymakers, academics and NGOs come together over a copious buffet where some alcohol smoothens out disagreements if they already exist. I guess I want to say that we, representing the “global health community” in those meetings, should keep our focus very much on why we are there and that we bear accountability for those who entrust us to be there. Strategic action plans or concrete policies should come out of these meetings that will really matter to reduce the gap in health equities. I miss the debate and definition what universal health coverage actually means. Does it mean coverage to a selected number of health care interventions or a right based package of appropriate, promotive, preventive, integrated, participative and rehabilitative health care as envisaged in the Primary Health Care concept of Alma Ata?

Remco van de Pas, Health policy adviser
Wemos Foundation


  1. First Consultation of the African Platform on Human Resources for Health, 11-13 October 2010, Nairobi
  2. First Global Symposium on Health Systems Research, 16-19 November 2010, Montreux, Switzerland
  3. Gostin L. et al., National and global responsibilities for health. WHO Bulletin Volume 88, Number 10, October 2010, 717-796
  4. see below
  5. Ooms G. Hammonds R. Van Damme W., The international political economy of global universal health coverage. Background paper for the global symposium on health systems research, Montreux 16-19 November 2010 (see reference 2)
  6. Francis Omaswa, Country ownership and accountability. A plea for governments to recognise their health obligations, for civil society to blossom, and for international partners to allow home-grown solutions to prevail. In: Africa Health, September 2010

World Health Report 2010
Health systems financing: the path to universal coverage

"The objective was to transform the evidence, gathered from studies in a diversity of settings, into a menu of options for raising sufficient resources and removing financial barriers to access, especially for the poor. As indicated by the subtitle, the emphasis is firmly placed on moving towards universal coverage, a goal currently at the centre of debates about health service provision." (Margaret Chan, WHO DG)

This year's World health report gives governments practical guidance on ways to finance health care. Taking evidence from all over the world, it shows how all countries, rich and poor, can adjust their health financing mechanisms so more people get the health care they need. It encourages the international community to support low and middle-income countries' efforts to increase health coverage. WHO highlights three key areas where change can happen: by raising more funds for health, raising money more fairly, and spending it more efficiently.”  


MMI Network: News, Events and Resources

MMI Network members: ACHAP – EPN
Welcome to the new Network members!

The Africa Christian Health Associations Platform ACHAP and the Ecumenical Pharmaceutical Network EPN were admitted on 5 November 2010 as new members of the Medicus Mundi International Network. Welcome!

ACHAP website:
ACHAP profile: MMI ePlatform

EPN website:
EPN profile:  MMI ePlatform

MMI Network campaign: Doctors with Africa Cuamm
This is a war photograph

Padua, 11 November 2010. "In Africa every year 4,5 million children below the age of 5 and 265'000 mothers die. These are figures of a genocide. Most of these deaths are linked with pregnancy and birth and could be prevented." - At its anniversary celebration in Padua, Doctors with Africa Cuamm launched their new campaign "Questa è una foto di guerra" - "This is a war photograph" for better access of mothers and newborns to care.

MMI Network workshop documentation
Health Systems Research and NGOs:
building up mutually beneficial partnerships
Antwerp, 11 November 2010

NGOs working in the field of international health cooperation and research institutions discussed past and ongoing cases of research partnerships, the win-win approach of academic research and NGO action and the related challenges. The workshop was a side event to the colloquium "Health Research towards Universal coverage” at the Institute of Tropical Medicine. The documentation of the workshop organized by the MMI Network, the Institute of Tropical Medicine Antwerp and Be-cause Health is available now, with inputs by Cordaid, Doctors with Africa Cuamm, Wemos, and Medecins sans Frontières.

MMI Network topic: Health Systems Strengthening
Analysing health systems to make them stronger

"The attention for Health Systems and Health Systems Strengthening has re-emerged in the frontlines of global debate since several years. This document aims to clarify the authors’ ideas and visions on health systems development by presenting a framework for description and analysis. The book outlines a framework that can be used by anybody wishing to analyze and strengthen Health Systems and it elaborates a vision for discussion." The final version of the publication used by the MMI Network as a key reference for its reflections on health systems strengthening is available now. Many thanks to Josefien van Olmen, ITM Antwerp, for her related keynote speech on “Health systems strengthening: Clarification, prioritisation & roles “ at the MMI workshop in Amsterdam, on 5 November 2010.

Josefien van Olmen et al.: Analysing health systems to make them stronger
ITM Antwerp, Studies in Health Services Organisation & Policy, 27, 2010.
Full document pdf:
Executive Summary pdf:

MMI Network paper: action medeor
Improving access to high-quality low-cost essential medicines
in Tanzania - assessing an NGO’s contribution

"This study shows that action medeor, though being a small NGO, has managed to contribute to improved quality of locally manufactured drugs in Tanzania – through capacity building and technology transfer – and to increased supply of medicines, especially to private non-profit customers, leading to better availability of medicines at health facility level. The success of the individual activities and their overall impact was and is strongly dependent on alignment with national priorities and on a regulatory framework being conducive." Thesis submitted by Christine Häfele-Abah (action medeor) to the Department of Tropical Hygiene and Public Health, Heidelberg University, August 2010.

MMI Network paper: Cordaid
Performance Based Financing can help to increase coverage in remote areas

“There is mounting evidence that Performance Based Financing (PBF) can improve utilization and quality of health care services. In a PBF system, the way health providers are paid is not entirely input-based, but at least in part made dependent on their output (performance based). The system is increasingly embraced by international agencies and donors, including Usaid and the World Bank. We argue that universal coverage of health insurance will not, by itself, automatically improve utilization and quality of services if not linked to a method of payment to health providers that encourages performance. PBF is a method of payment that stimulates health providers to deliver more and better services. It can be applied in conjunction with health insurance. We describe the first results of a PBF project, implemented by the Dutch NGO Cordaid, and its Indonesian partner PT. Bahana, in a remote area on the island of Flores in Indonesia.” Article by EPLM Schoffelen, Haryoko and JPM Tacoy published on:

Call for Papers: MMI Network News, December 2010
High on the political agenda in 2011: non-communicable diseases

“Raising the priority given to NCDs in health and development has been a key priority for WHO since the development of the Global Strategy for the Prevention and Control of NCDs (2000) and the endorsement of its Action Plan by the World Health Assembly in 2008. A High-level Meeting at the UN General Assembly in September 2011 will galvanize action to halt and begin to reverse the prevalence of premature deaths from NCDs.” (WHO concept note for an informal meeting with NGOs on the prevention and control of non-communicable diseases in low- and middle-income countries, 1 November 2010)

We recently invited MMI Network members to propose a thematic focus for every issue of this newsletter. We will start this feature already in the next issue of the MMI Network News - with a focus on non-communicable diseases. If you have news or resources to contribute, please let us know.

Feedback to last MMI Network News

NGOs contribute to health systems strengthening
- a matter of course, isn’t it?

The editorial in the October issue of the MMI Network News discussing the NGO Code of Conduct for Health Systems Strengthening was also forwarded to two listservs (Afro-Nets and PHM Exchange). This lead to some interesting feedback: 

„I appreciate the concern of Medicus Mundi International that raised this sensitive point. I would suggest to them to broaden their discussion when they'll meet in Amsterdam. A 'new' aspect of health care delivery in many poor countries is the role played by the private sector. It is widespread, day by day, rapidly. A vivid example is here in Nyala where one can see plenty of private doctors, local healers, private clinics, private hospitals, private pharmacies, plenty of drugs and plumpynut ...but still children do die from malnutrition and common diseases. A drug for any illness is not the correct approach, I think you agree. We should be together to declare with one voice that children under fives and pregnant women should receive FREE SERVICE.“ (Massimo Serventi, Nyala Pediatric Centre, on PHM-Exchange)

„In Nigeria, the presence of NGOs weakens the formal health sector because the NGOs offer more attractive remuneration, and even in hospitals where they exist alongside the formal health services, the government employees prefer to work there. In majority of the secondary and tertiary hospitals in Nigeria where HIV/AIDs counseling and treatment pharmacies exist, they are so well furnished and equipped that every Pharmacist in the hospital would prefer to work there, thereby downplaying on the poorly equipped government pharmacy within the same hospital, PLEASE IS THIS STRENGTHENING OR WEAKENING?“ (Uamaka Okafor on Afro-Nets)

„I am glad this subject has come up. The good news is that there are thousands of NGOs interested in health care activities ... but they are not delivering their services very effectively where they are most wanted. Bottom line, nobody knows where they are working and what they are doing. Nobody seems to know where they would be most needed and could be doing the most good. This should not be an ideological argument about public or private sector ... free or paid ... but about needs, resources and how to get the best possible outcomes.“ (Peter Burgess on Afro-Nets)

MMI Network News, October 2010: ePlatform
NGO Code of Conduct for Health Systems Strengthening:
MMI Thematic guide: Health systems strengthening:

International Health Policy: MMI Updates

Since we started to use the real-time short messaging service "Twitter", we published there already more than 600 bits and pieces of news on international health policy. Each update is 140 characters or less - these are the rules of the game. Just enough for a headline, eventually an author, a date, the source – and a shortened link to the website where you find the full information. Have a look at some of our “tweets” published during the last month:

  • WHO Europe: Regional high-level consultation on non-communicable diseases, 25-26 Nov 2010 in Oslo
  • Mapping user fees for health care in high-mortality countries: evidence from a recent survey. Sophie Witter in HLSP
  • Private delivery care in developing countries: Trends and determinants. A Pomeroy et al., USAID DHS working paper
  • How universal is access to reproductive health? A review of the evidence. E Loaiza/S Blake, UNFPA 2010
  • Which path to universal health coverage? Perspectives on the World Health Report 2010. Sara Bennett et al. in: PLoS Med
  • Millennium development goals for the rich. David Sogge on TNI
  • WHO Executive Board, 128th Session, 17-25 January 2011: provisional agenda
  • Ailing Global Forum for Health Research joins COHRED. Aisling Irwin on SciDev.
  • Caring for the carers. WHO launches international guidelines to protect health workers against HIV and TB
  • Hidden cities: unmasking and overcoming health inequities in urban settings. WHO/UN-HABITAT report
  • Biofortified crops ready for developing world debut. But is the developing world ready for them? T Anderson, SciDev
  • The long and bumpy road to Universal Health Coverage. Karen Grepin on: Global Health Blog
  • Key players in global health. How Brazil, Russia, India, China and South Africa are influencing the game. K Bliss, CSIS
  • 19 November is World Toilet Day - and this is not just funny.
  • How do you do research on health systems when we don't actually know what they do? Karen Grepin on: Global Health Blog
  • Can research make health systems strengthening sexier? Nandini Oomman on: CGDev Global Health Policy blog
  • Defining research to improve health systems. Robert Terry et al. in: PLoS Medicine 2010
  • Providing coverage in times of crisis and beyond. World Social Security Report 2010/11, by ILO (pdf)
  • Background papers commissioned by WHO for the Global Symposium on Health Systems Research, Montreux, 16-19 November
  • Health workforce: critical pathway to universal health coverage. M Jimba et al., backgr. paper for HSR Symposium (pdf)
  • The political economy of universal health coverage. D Stuckler et al., background paper for Global HSR Symposium (pdf)
  • Faith-based organizations: Serving and uniting the health sector. Erika Pearl on:
  • Church leaders an obstacle to preventing maternal deaths. Ch van der Westhuizen on unsafe abortion in Africa, IPS news
  • The World Health Organization policy on global women's health: New frontiers. Jennifer Requejo Harri et al. in: jwh
  • Swiss contributions to human resources for health development in low and middle income countries. Wyss/Weiss, Swiss TPH
  • Let's take control of diabetes. Now. 14 November was World Diabetes Day
  • Global health systems must be transformed to realize full potential of new technologies. J Frenk at mHealth Summit
  • Research priorities for malaria elimination. Lancet four-paper series
  • Global tuberculosis control 2010. Annual WHO report
  • World Pneumonia Day 2010: Preventing Pneumonia
  • Chronic diseases and development. Lancet series in view of UN High-level Meeting on chronic non-communicable diseases
  • Rethinking health-care systems: a focus on chronicity. P Allotey et al. in: The Lancet (free registration required)
  • Chronic diseases: global action must match global evidence. R Beaglehole, R Horton, intro to new Lancet series
  • Hygiene, sanitation, and water: Forgotten foundations of health. Bartram/Cairncross, intro to new PLoS Medicine series
  • Acute Respiratory Infections Atlas: "An in-depth look at a forgotten pandemic killing more than 4 mio people a year"
  • Using global health initiatives to strengthen health systems: A civil society perspective. J Cohn et al. in: GlobPubHea
  • Where have all the donors g one? Scarce donor funding for non-communicable diseases, R Nugent/AB Feigl, CGDev WP
  • Examining health-care volunteerism in a food- and financially-insecure world Kenneth Maes in: WHO Bulletin
  • Enhancing health worker and health system performance. Uganda case study. Charles W. Matsiko, PPE campaign
  • Tanzania: Health facilities become "white elephants" as staff and medicine shortages rock them. E Madhidha, sikika
  • Women’s and children’s health: from pledges to action. Flavia Bustreo / Julio Frenk in: WHO Bulletin
  • Neglected diseases: Focus on HIV prevents us from curing a billion people, say scientists. Robin McKie in: The Observer
  • Human Development Report 2010 — The Real Wealth of Nations: Pathways to Human Development UNDP
  • Health systems governance for health equity: Critical reflections. Ronald Labonté in: Revista de Salud Pública
  • Universal access: right here, right now. iasociety report on outcomes of the XVIII International AIDS Conference
  • Are you MDGs-skeptic? I am. Great blog by PHM activist Claudio Schuftan on: Social Medicine portal
  • The parlous state of palliative care in the developing world. Priya Shetty in: The Lancet (free registration required)
  • Malaria elimination. A new Lancet series examines the technical, operational & financial challenges of tackling malaria
  • Rethinking the 'global' in global health: a dialectic approach. Kayvan Bozorgmehr in: Globalization and Health
  • Performance Based Financing can help to increase coverage in remote areas. EPLM Schoffelen et al. on: cordaidpartners
  • Human subjects research ethics: A field training guide for community trials. MW Merritt et al. in: PLoS Medicine
  • Financing public health in Africa. Susan Anyangu-Amu in: IPS news
  • Progress and challenges in neglected tropical diseases. A Lancet editorial discusses the WHO report to be launched last week
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