Sharing knowhow and joining forces towards Health for All

MMI Network News, 27 March 2015

World Development Report 1993: Investing in Health
World Development Report 1993: Investing in Health

A social contract for global health investments in times of resilience (editorial)

Dear reader,

The last year saw the re-emergence of a century-old economic idea, namely that investing in health is (good) value for money. The Lancet Commission on Investing in Health (CIH), prompted by the 20th anniversary of the 1993 World Development Report, has argued that a Grand Convergence in health is possible by the year 2035. Global health 2035: a world converging within a generation, the CIH report, calculated that “for every dollar invested in convergence related interventions, the economic benefits are 9-20 times higher”. 

The notion that investing in health leads to (potentially enormous) economic returns is nothing new, though. By way of example, let’s have a look at excerpts from a medical article from the Dutch Colonial Indies, 1879, modern Indonesia:

”The Deli planters association purpose was to implement unity in the handling of the workforce, and to co-operate with regard to importing workers and organizing work. According to this arrangement, the workers brought in from overseas were obliged to work on the plantation for a fixed wage and under stipulated conditions, while the employer was bound to provide housing, food, and, amongst other things, free medical treatment and medicine. This sort of agreement was of the greatest importance for the viability of the enterprises because of the huge losses which sickness caused to the productivity of the plantations. And a high mortality rate was equally damaging to the company’s good name and could cause problems for recruiting new workers. Humane and economic considerations clearly went hand in hand” (Source: Dutch Medicine in the Malay Archipelago, 1816-1942, p.75).

The Dutch did not call the project “Global health 1890, a convergence within a generation” (generations were considerably shorter then); the colonial administration found the title a tad too revolutionary and just considered it “robust tropical medicine”.

On a more serious note, key questions regarding the ‘Global Health 2035’ agenda are then: Who (really) benefits (most) from the foreseen economic benefits, in the long run, and who (really) benefits (most) from the reduced mortality in LMICs? 

National and global political economy discourses and the debate on social justice and health equity come into play here. Global Health 2035 uses the concept of growth in a country’s ‘full income’, which is mainly GDP change adjusted for the value of mortality change (“the income growth measured in national income accounts plus the value of additional life years (VLYs) gained in that period”). But the report doesn’t refer to ‘full income‘ distribution over socio-economic quintiles nor does it take into account negative externalities impacting on health (e.g. natural resource depletion and climate change). The report also fails to fully recognize the massively unequal and unjust social and living conditions that shape the health status of communities, the so-called upstream determinants of health.  

The CIH recommendation for progressive universalism as a pro-poor pathway towards Universal Health Coverage is presented as an efficient way towards health and financial protection.  We will not deny it has obvious merits. However, if we really want health inequalities to reduce substantially, UHC must be embedded in broader social protection schemes, both at national and global levels.  So far the thinking on a grand convergence for global health has not included reflections on global social protection mechanisms.  To kickstart this – in our opinion vital – debate in a further globalizing world, the health community could perhaps discuss and frame UHC in the context of ILO’s Social Protection Floor initiative. The example from the Deli Planters Association from more than a century ago demonstrates that a social contract is needed to guarantee both human security and economic objectives.  As the economic case for health investments is nowadays made for many global health topics, such as maternal, neonatal and child health or the health workforce,  we feel there should also be some reflection on how universal and equitable access will be guaranteed to such services as part of the Post -2015 development framework. In short, how can a social contract theory be applied to current investments and governance arrangements in global health?  Is it still national governments that have the main responsibility for guaranteeing their citizens’ rights, or should there be supranational arrangements, involving also non-governmental actors, at the regional (e.g. EU) or at the global level?     

The latest episode in the ‘investment for health’ saga is the notion of ‘resilient health systems’. This has become a major lesson of the Ebola outbreak in West-Africa. In the words of Jim Yong Kim, medical doctor by training but more importantly the president of the World Bank group:

“The other main goal of a pandemic facility (by the World Bank) is to promote greater country investments in preparedness, which starts with having a strong, resilient health system. The Ebola crisis lays bare the consequences of inadequate public health capacity, from disease surveillance and laboratory analysis to frontline health services and community health workers: People die; economic growth rates decline; and countries, their neighbors, and the entire world, are put at risk.”

Although still very much in love with UHC, WHO has also rather eagerly embraced the concept of a ‘resilient health system’, so resilience is likely to become a leading theme in the health SDG and broader post-2015 development framework. I am still struggling to fully understand the concept of resilient health systems, its scope and implications from a human rights and health equity perspective. If you already see clearer, please do not hesitate to get in contact.

In the meantime, let us learn from history and think of social contracts fit for this era. It might make the planet and the human species just a tiny bit more resilient.

Remco van de Pas, MMI Board member
ITM Antwerp,
Editorial also posted in the IHP Blog

MMI Network: Events, news, resources

Network event: Medicus Mundi Switzerland
The Future of the Swiss Engagement against Malaria
Basel, 22 April 2015

Malaria remains an important public health challenge and a main cause of morbidity and mortality in many countries. Therefore it is the major goal of the Swiss Engagement to support research and effective and sustainable interventions and strategies to further reduce malaria prevalence and incidence. The Technical Exchange Event 2015 “The Future of the Swiss Engagement against Malaria” organized by the Swiss TPH and the Swiss Malaria Group provides insights on latest research trends and strategies in the Swiss engagement against Malaria. (The Swiss TPH is a member of Medicus Mundi Switzerland; the Swiss Malaria Group is hosted by MMS).



Network event: Medicus Mundi Switzerland
Community Participation in Public Health: What’s the Added Value in Research and Implementation
Basel, 23 April 2015

The Swiss TPH Spring Symposium 2015 will provide a platform to reflect on the added value of community participatory approaches in public health. Starting with an overview of the current major debates in the field, presentations and discussions will then focus on the added value and challenges in putting into practice these approaches. Speakers will present various ways and reasons for involving community members in clinical and social science research, as well as in project implementation. Critical perspectives will be addressed such as the feasibility, sustainability and equity of these approaches and whether these approaches can actually contribute to increasing quality of research and services, stronger accountability within the health system, and ultimately better health outcomes, with a particular focus on the most marginalised and vulnerable populations.


Network event: Medicus Mundi Switzerland
HIV/AIDS and vulnerable groups – no one left behind
Berne, 7 May 2015

This year’s annual aidsfocus conference will focus on vulnerable groups such as Sex workers, injecting drug users; migrants or prisoners. In most countries, these groups tend to have a higher prevalence of HIV infection than that of the general population because (i) they engage in behaviours that put them at higher risk of becoming infected and (ii) they are among the most marginalized and discriminated against populations in society. At the same time, the resources devoted to HIV prevention, treatment and care for these populations are not proportional to the HIV prevalence - a serious mismanagement of resources and a failure to respect fundamental human rights. If we want to achieve the ambitious goal to end the AIDS epidemic by 2030 we cannot leave anyone behind. ( is a project coordinated by the Network Medicus Mundi Switzerland)


Network conference report: ACHAP
The role of faith based health services in contributing to universal health coverage in Africa

Nairobi, 23-26 February 2015. The Africa Christian Health Association’s Platform (ACHAP) hosted a successful 7th Biennial Conference of the Africa Christian Health Associations at the Safari Park Hotel, Nairobi in collaboration with ACHAP Secretariat and funding support by various partners. The Conference theme was "The role of the faith based health services in contributing to universal health coverage in Africa”. The conference which attracted 126 delegates from Africa, Europe and USA discussed global commitments and developments towards universal health coverage and the opportunities for faith based health services in scaling up their contribution towards UHC.


Network report: Health Poverty Action
Casualties of War: How the War on Drugs is harming the world’s poorest

Health Poverty Action has launched a report calling for the global development sector to rethink its approach to the failing War on Drugs. Entitled ‘Casualties of War: How the War on Drugs is harming the world’s poorest’, the report emphasises how drugs policy is very much a development issue: “If, as international NGOs, we are serious about dealing with the root causes of poverty and not just the symptoms, we cannot afford to ignore drug policy. It’s time we recognised the threat that unreformed global drug policy poses to our attempts to tackle poverty worldwide. The sector can no longer be absent from debates on drug policy reform.”


Network report: Cordaid
Disaster response: Sendai Framework "shows signs of weakness"

 "Local communities, especially in fragile areas will get a central role in disaster risk reduction. Governance and programs will be formulated from their perspective. The role of organizations such as Cordaid is also recognized and established.” However, Jeroen Alberts reaction to the Sendai Framework is not merely positive. The Post-2015 framework for Disaster Risk Reduction was adopted this week at the UN WCDRR in Sendai, Japan. As part of a Dutch delegation, headed by Minister Ploumen of Trade and Development Cooperation of The Netherlands, Alberts attended Sendai on behalf of Cordaid. From the 14th until the 18th of March, the conference brought together governments and NGO delegates from around the world to chart the future management of disaster risks.


Network people: Medicus Mundi International
Get well soon, Nick!

Nick Lorenz, President of the MMI Network, suffered a stroke while he attended a conference in Maputo, Mozambique, at the end of February. Thanks to the immediate action of some colleagues, Nick received prompt and appropriate care through the Instituto do Coracao in Maputo. A week later he was repatriated to Switzerland. After initial care at the University hospital in Basel, he is now undergoing an intensive rehabilitation program in a specialized clinic. Get well soon, capo!


A luta continua! Strengthening or weakening health systems? Geneva, 23 May 2015, MMI Annual Assembly and WHA side event

A luta continua! Strengthening or weakening health systems? Geneva, 23 May 2015, MMI Annual Assembly and WHA side event

The General Assembly of the MMI Network will take place in Geneva, at the end of the first week of the 68th World Health Assembly. A luta continua – the struggle continues – is a good slogan for the adoption of the MMI Network Strategy 2016-20 in the business part of the Assembly, but also for the ongoing need to reflect about the influence of international health cooperation and a globalized health business on national health systems. Based on the movie “A luta continua” (Medicus Mundi Catalunya) and the case of Mozambique, a public workshop linked to the MMI Assembly and considered as civil society side event to the World Health Assembly will provide a good opportunity for the dialogue on what it takes to strengthen – or weaken – a national health system.

Provisional program:
09:30 to 12:00: MMI Assembly
12:00 to 13:30: Lunch
13:30 to 16:00: Movie "a luta continua" and public workshop / WHA side event

There will be a dinner for MMI Network members on Friday evening, 22 May, and as every year, MMI Network members and project representative are welcome to register as members of the MMI delegation at the World Health Assembly. Save the date(s) and start organizing your journey, including your individual hotel reservation!


International Health Policy: MMI Updates

Bits and pieces of news on international health policy: each “MMI update” is 140 characters or less - these are the rules of the game on Twitter. Just enough for a headline, eventually an author, a date, the source – and a link to the website where you find the full information. Have a look at some of our “tweets” published during the last month. As usual, it’s a bit much, so take it or leave it.

Universal health coverage
Health systems strengthening
Health services, health financing

Within our Means. Why countries can afford universal health coverage UHC

Prince Mahidol Award Conference 2016, “Priority Setting for Universal Health Coverage”: Call for abstracts

"Investing in health systems is an investment in both better health and stronger economic growth." Jim Kim

Putting the ‘universal’ in healthcare. Lant Pritchett and Gulzar Natarajan

Disaggregating the Universal Coverage Cube: Putting Equity in the Picture Marc J. Roberts et al.  

Advancing political economy of global health to understand and influence the drivers of UHC

Financing Universal Health Coverage in the post2015 agenda. UNSDSN issue brief

Universal health coverage: reaching a consensus. David Nicholson

WHO DG Margaret Chan addresses ministerial meeting on universal health coverage in Singapore
(How can she state: "Health is likely one of the most precious COMMODITIES in life" ?? Unfortunate end of a great speech)

Strengthening emergency and essential surgical care and anaesthesia as a component of UHC. WHO report to WHA68

Results Based Financing in Uganda: ready for take-off this time? Aloysius Ssennyonjo 

Results Based Financing: engaging communities to strengthen systems in fragile contexts

Performance payments: funders worry about "double counting" – but what about "double demanding"? Bll Savedoff

Donor and domestic financing of Primary Health Care in Low Income Countries. R. Paul Shaw et al.

MMI thematic guides: 


See also below:
Health beyond 2015
Twitter: #UHC


Health policy and systems research

Uganda: Evidence for Informing Health Policy Development in Low- Income Countries (LICS): J Nabyonga-Orem / R Mijumbi

The (conflicted) role of researchers as advocates. Nasreen Jessani

Health research improves healthcare: Help the WHO spread such benefits globally. Stephen R Hanney et al.

Learning from each other: Bridging the divide between ideas and action in health systems. J Frenk and O Gómez-Dantés

WHO calls for papers for journal series on "Informing the Establishment of the WHO Global Observatory on Health R&D"

MMI thematic guide:


Human resources for health
Migration of health professionals

Monitoring progress on implementation of @WHO #HRH Code of Practice: All about the second round of reporting (2015)

(un)Happy with implementation of HRH Code of Practice in your country? Submit a report to WHO (see guidelines, part 3) 

Review of the relevance and effectiveness of the WHO HRH Code: Background

Public hearing to review relevance and effectiveness of WHO Code of Practice: Call for statements (deadline 6 April)

WHO Global Code of Practice on the International Recruitment of Health Personnel (2010)

Crucial times for Global Health Workforce Governance. Remco van de Pas, Linda Mans

Health workforce investment: "A strategy for the creation of employment opportunities & a driver of economic growth"

Health Workforce 2030: UN officials and key actors support development of a global HRH strategy. GHWA video

Health workers as agents of sustainable development. Lancet comment

Republic of Moldova: WHO video on health workforce migration - timely for Code of Practice review.

Ireland’s medical brain drain: migration intentions of Irish medical students. Pishoy Gouda et al.

Role of ‘hidden’ community volunteers in community-based health service delivery platforms. Leon et al.

"In 2014 alone, 5,718 highly trained Ethiopians were issued a Green Card for the US, many of them medical doctors."

How does context influence performance of community health workers in low- and middle-income countries? MC Kok et al.

Trading health for oil? Uganda should not export its health workers. Labonte et al.

Health worker export from Uganda to Trinidad & Tobago: Civil Society appeal to UN

Does the world have enough midwives? GHWA report on recent Geneva dialogue on midwifery

Midwifery – more than just ‘being with women’

MMI thematic guides: 

Twitter: #HRH, #healthworkers #healthworkerscount, #3GFHRH


Access to medicines and vaccination
Medical research and development
Communicable diseases and diseases control

World TB Day 2015: Gear up to end TB

Introducing the WHO End TB Strategy WHO advocacy brochure

Testing and Treating the Missing Millions with Tuberculosis

Time for a jumpstart: accelerating access to new and promising DR-TB drugs.

Every day 1000 people get sick with tuberculosis in the European Region!bn97rp

The Movement of Multidrug-Resistant Tuberculosis across Borders in East Africa Needs a Regional and Global Solution

Investing to Overcome the Global Impact of Neglected Tropical Diseases. WHO Report

Progress made in implementing resolution WHA67.25 on antimicrobial resistance AMR. WHO secretariat report for WHA68

UNAIDS hosting first of two consultations on next Strategy. Have your say

Global technical strategy for malaria, 2016-2013. WHO secretariat report and draft strategy, for WHA68

Pharma accused of restricting access to hepatitis C drug in poor countries. Sarah Boseley

A public health approach to Hepatitis C control in Low- and Middle-Income Countries. Suthar and Harries

Communicable disease control programmes and health systems: an analytical approach to sustainability.


Ebola situation and response
Ebola and health systems
Ebola and the state of global health governance

WHO DG Margared Chan has commissioned a panel of independent experts to assess all aspects of WHO’s Ebola response

A Wake-up Call: Lessons from Ebola for the world's health systems.

Strengthening the Detection of and Early Response to Public Health Emergencies: Lessons from Ebola

The Ebola outbreak has shown the power and potential of a coordinated, global response. Kathy Calvin

After a year fighting Ebola, we must change our approach to global health risk to save lives

Gender-blind global health institutions ignore misery for women in Ebola-affected regions

Pushed to the limit and beyond. MSF report

Ebola crisis brutally exposed failures of the aid system. Lisa O’Carroll

Vaccination must be scaled up in Ebola-affected countries. WHO news release

Ebola: How can we integrate science, policy and politics? Melissa Leach

Ebola: Time to strengthen health systems and global health governance. Hayley MacGregor

Ebola and lessons for development. IDS practice paper and project

The global backstory to the #Ebola outbreak. Ronald Labonte

MMI thematic guide: Ebola voices 


Women’s and children’s health
Sexual and reproductive rights and health

Saving Lives, Protecting Futures: Every Woman Every Child Progress Report 2015

Strategies toward ending preventable maternal mortality. WHO strategy paper is out.

The uses of discomfort. Towards a new Global Strategy for Women's, Children's and Adolescents' Health.

Ten top issues for women's health. WHO feature for International Women's Day, 8 March

Working towards an end to FGM. Jules Morgan

Maternal mortality: a cross-sectional study in global health. S. Sajedinejad et al. @

MMI thematic guide: 


Prevention and control of NCDs
Nutrition, Disabilities, Mental Health, Care

New UNDP and WHO publication on helping UN respond to NCDs at country level

Ending childhood obesity: a multidimensional challenge. Peter Gluckman, Sania Nishtar, Timothy Armstrong

WHO Interim Report of the Commission on Ending Childhood Obesity is now open for comment. Make yourself heard!

Obesity 2015. A Lancet series

The topic for WHO World Health Day 2015 is food safety

Tobacco use declining but intensification needed in reduction and control efforts. WHO

Tobacco-free world. Lancet series and editorial

Governments commit to advancements in dementia research and care

Sweetening their own deal. The (US) sugar industry’s continuing efforts to subvert public health policies.

MMI thematic guide: 


Equity and human right to health
Social determinants of health
Poverty and social protection

World Social Forum, 24-28 March 2015 in Tunis

Income inequality and health. Ronald Labonte

Disaggregating the Universal Coverage Cube: Putting Equity in the Picture Marc J. Roberts et al.  

Let’s break the vicious circle of inequality in health and access to medicines. Leïla Bodeux

Why language matters: "social determination" vs. "social determinants" of health. Jerry M Spiegel et al.

A response to ‘The Social Determinants of Health: Why Should We Care?’

“Fighting disease and fighting poverty go together. If we just give pills, we'll never end disease.” Agnes Binagwaho

Lack of social safety net hampers fight against killer diseases.

MMI thematic guide: 

Twitter: #SDH, #HIAP


Global health governance and policy
Political and economic determinants of health

Who lives and who dies? By Paul Farmer on stupid deaths & global health care

Engaging the public on global health. Sara Gorman

Health and politics for 2015 and beyond. Ted Schrecker and Eugene Milne

Power and Priorities: The Growing Pains of Global Health. Karen Grepin

Advancing political economy of global health to understand and influence the drivers of UHC

Health in all policies training manual. WHO 2015

Public-Private-Partnerships (PPPs) don’t work: The many advantages of the public alternative. D Hall

Trade Policy and Public Health. Sharon Friel et al.

Could the TTip trade deal undo development gains? Barbara Crowther

EU trade secrets directive threat to free speech, health, environment and worker mobility

Improving regulatory capacity to manage risks associated with trade agreements. Helen L Walls et al.

Trading Health? The FPH report on the Transatlantic Trade and Investment Partnership TTIP

Trade and investment agreements: a call for evidence. Independent Panel on Global Governance for Health

New ODI report: how democratisation contributed to better health and education in Ghana

Illicit financial flows, human rights and the post2015 development agenda. Report to UN OHCHR


MMI thematic guides:

See also: Ebola, WHO reform, development
Twitter: #globalhealth #healthgovernance


World Health Organization
WHO reform and financing

Provisional agenda of the 68th World Health Assembly, 18-26 May 2015

The future of WHO: outsourcing? Ranu S Dhillon

Governance within the World Health Assembly: How WHO Member States contribute to global health governance

The path-dependent design of international organizations: Federalism in the WHO. Tine Hanrieder

MMI thematic guide 


Health beyond 2015
MDGs and SDGs

We need a sustainable development goal 18 on global health security. Ilona Kickbusch et al.

The health goal in the post2015 SDGs: Not sufficiently transformative. Ilona Kickbusch

Health in the post2015 SDGs: ready for a paradigm shift? Kent Buse and Sarah Hawkes

“The SGDs illustrate powerfully the limits of the development community's fetish with action plans." Bill Easterly 

Financing Universal Health Coverage in the post2015 agenda. UNSDSN issue brief

Need to be counted to count? Statisticians vs. politicians, technical or politically negotiated SDGs? Saba Loftus

Statistics for the post2015 SDGs: The devil is in the indicators. Roberto Bissio

Technical report by UNSC on process of development of indicator framework for goals and targets of post2015 agenda

Indicators and a monitoring framework for SDGs

Do you believe in the transformative value of the proposed SDGs? - they do:

Do you believe in the transformative value of the proposed SDGs? - they don't:

MMI thematic guide:

Twitter: #post2015 #SDGs


Development, aid and international institutions

The Death of International Development. Jason Hickel

The NGO sector must support activism, not governments. Ben Phillips

Aid agencies have become self-serving corporations dressed in the clothing of compassion. Ian Birrell

Partnering with big business: 4 key lessons for NGOs, based on new Oxfam report

Some healthy scepticism about 'Citizen Engagement' (and why I'm excited about MOOCs)

Tracking development assistance for health to fragile states: 2005–2011

Theory of change: from targets to meaningful effects. Rojan Bolling and Karlijn Muiderman

14 changes (UK) NGOs must make to be relevant in 10 years time.

International development aid creates dependence instead of self-sufficiency. The case of Ethiopia.

MMI thematic guides:


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