Editorial: The 2013 World Health Report: Several missed opportunities, one imminent danger
Dear reader,
Let me start with three truisms: “Universal health coverage cannot be achieved without evidence from research”, “research into health services and systems gets relatively little support and tends to be narrowly focused”, and “there is a particular need to close the gap between existing knowledge and action”. No health policy or health systems researcher would disagree with any of these quotes from the World Health Report 2013: Research for Universal Health Coverage (1). But what kind of evidence is most needed, how can a systems perspective be brought to the fore, and how will the research advocated for really improve health for all? In my opinion, the present World Health Report falls short in answering these questions, in the first place because it is narrowly focused itself.
The core of the report (pages 31-89 of 146) consists of the feel-good message that “research for health is on the rise worldwide”, followed by 12 examples “of studies that show how research can address some of the major questions about achieving universal health coverage”. The promise is made that these examples “rang(e) from the prevention and control of specific diseases to the functioning of health systems”. At first sight, the promise is held: six case studies are directly related to disease control and six are more related to health systems. But the report articulates none of these from within a systemic perspective that is beyond ‘programmatic advantages’ and takes into account the interactions of actors and interventions, which is a little surprising to say the least.
Wasn’t it WHO that four years ago published Systems thinking for health systems strengthening (2), rightly recognizing health systems as complex adaptive systems and promoting systems thinking as “an essential approach for strengthening health systems”? Or just about a year ago, Health policy and systems research – a methodological reader (3), 474 pages of advice to improve the evidence base for health policy making and health systems strengthening? And is systems thinking not “key for policy and decision makers dealing with universal health coverage”, as – among others – Medicus Mundi International (4) argues?
A second missed opportunity is the very fragmentary coverage of social determinants as part and parcel of research for universal health coverage. Social determinants are mentioned sporadically, yet not explicitly in the examples, and equity is treated only superficially. Yes, “indicators should be disaggregated”, but when will we start unpacking processes that reproduce inequity? Will categorical data be enough to “measure and understand the problem (of health inequities) and assess the impact of action”, as argued by WHO (5) and for Developing an evidence base for political action (6)? Will this be sufficient for an equity-focused research agenda (7) in support of truly universal health coverage?
Equally under-addressed is research on Health-in-All policies (8), in spite of being a promising way forward to tackle health inequities and to arrive at fair or at least proportionate universalism. The World Health Report 2013 recognizes the need “to develop research that can enhance understanding of how intersectoral policies can improve health”, but only as “an additional and complementary challenge” and by adding that “because many more questions can be asked than answered, it is vital to set priorities”.
These three missed opportunities are interrelated. What unites them is a lack of people centeredness. At best, uptake of the report might lead to more of the same. There is however a risk that worse will happen. Research for Universal Health Coverage makes a strong call for “finding local answers to local questions”. Admittedly, coverage gaps and health inequities have local manifestations, worthy of research. But doesn’t the combination of a more-disease-than-people-centred approach and local priority setting encompass a peril: chances are that universal health coverage then gets stuck in selective health coverage, just like comprehensive primary healthcare watered down to selective primary healthcare three decades ago? We all know what that meant. The world deserves better, and we should feel obliged to research deeper and broader.
Guest editorial by Werner Soors, ITM Antwerp,
First published in: IHP Newsletter 234, 23 August 2013
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References:
- World Health Report 2013: Research for Universal Health Coverage
www.who.int - Systems thinking for health systems strengthenin
whqlibdoc.who.int - Health policy and systems research – a methodological reader
www.who.int - MMI discussion paper on UHC published in August 2013: see below
www.medicusmundi.org/ - Closing the gap in a generation Health equity through action on the social determinants of health
whqlibdoc.who.int - The social determinants of health: Developing an evidence base for political action
www.who.int - Ostlin et al., Priorities for Research on Equity and Health: Towards an Equity-Focused Health Research Agenda
www.plosmedicine.org - Health in All Policies. Seizing opportunities, implementing policies
www.euro.who.int
MMI Network: Events, news, and resources
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Network event: Memisa / Medicus Mundi International
Health-y answers to comple#ity: Are we able to move beyond the control panel?
Brussels, 27-28 November 2013, Medicus Mundi International Network meeting hosted by Memisa and linked to the annual seminar of Be-cause Health. The seminar will take place on 28 November at the Egmont Palace in Brussels. Registration opens on 6 Septembe. If the event’s title is confusing, this might even be intentional: the conference is all about providing health care in a complex environment and how to deal with this complexity. The Assembly, a Board meeting and workshops of the Medicus Mundi International Network are scheduled for 27 November.
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Network event: Medicus Mundi Switzerland
Universal health coverage and global health beyond 2015
Basel, 6 November 2013. How can global health policy be structured to ensure that even the poorest people in developing countries have access to health services? That’s one of the topics of the ongoing international debate on the new development goals for the period beyond 2015. The World Health Organization (WHO) is advocating universal health coverage (UHC) as a way of making health services affordable and accessible to all. At its this year’s symposium, Medicus Mundi Switzerland will be discussing how UHC is defined and what form it should take in the light of the new development policy agenda..
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Network event: Medicus Mundi Switzerland
Global Health: Interconnected Challenges, Integrated Solutions
Geneva, 15-17 April 2014. “During recent decades significant progress has been made to focus policy attention and channel new financial resources towards global health issues. Despite this, the challenges facing our global community are becoming increasingly complex and inter-connected.” The Geneva Health Forum is organized by the Division of International and Humanitarian Medicine at the Hospitals of the University of Geneva, a member of Medicus Mundi Switzerland. Submissions of abstracts close on 30th September 2013.
> http://ghf.globalhealthforum.net
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Network paper: Medicus Mundi International
Questions and answers on Universal Health Coverage
…and some more comments and open questions. MMI discussion paper
Like many other actors in global health, the Medicus Mundi International Network (MMI) is overwhelmed by the attention given to the concept of Universal Health Coverage (UHC) in the last two years, mainly by the World Health Organization and related to the debate on health in the post-2015 development agenda. We have followed this debate with great interest (see: MMI thematic guide), as the “UHC hype” brought health systems strengthening, a core concern of MMI, back to the top of the global health agenda. The discussion paper compares key elements of the concept of UHC as promoted by the World Health Organization with our own ambition of Health for All
> Discussion paper: http://www.medicusmundi.org
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Network paper: Medicus Mundi Spain
Healthcare in the Development Agenda post 2015
A declaration by Medicus Mundi Spain approved at their Jubilee Assembly in June 2013 The proposal of Medicus Mundi Spain: Universal, Global and Public Health Coverage.
> Spanish version: FAMME website
> English version: download
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Network resource: Medicus Mundi Switzerland
Formation de haut niveau “Diplomatie et santé”
The Graduate Institute of International and Development Studies, a member of Medicus Mundi Switzerland, will organise its first executive course on GHD in French language this November in Geneva. Registration is open until mid-September.
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Network paper: EPN / Medicus Mundi International
The role of faith-inspired health care providers in Sub-Saharan Africa and public-private partnerships
The World Bank Publication “The role of faith-inspired health care providers in Sub-Saharan Africa and public-private partnerships (Vol. 1 of 3): Strengthening the evidence for faith-inspired health engagement in Africa” published in November 2012 is now available online. The reader edited by Jill Olivier and Quentin Wodon includes, among others, an article on the MMI contracting research (2009) and an EPN paper on access to medicines.
> WB publication: http://bit.ly/156FNP1
International Health Policy: MMI Updates
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Health systems strengthening
Health services, health financing
Health systems research
- Embedding health policy and systems research into decision-making processes in LMIC. Adam D Koon et al.
http://www.health-policy-systems.com/content/11/1/30/abstract - mHealth innovations as health system strengthening tools: common applications and visual framework. Labrique et al.
http://www.ghspjournal.org/content/1/2/160.full - Annotated literature review: African actors, global health governance and performance-based funding. GW Brown et al.
http://www.equinetafrica.org/bibl/docs/Diss%2098%20PBF%20Lit%20Rev%20June%202013.pdf - We cannot afford to leave the for-profit private health sector unregulated in Africa. Editorial by Jane Doherty
http://equinetafrica.org/newsletter/index.php?issue=150#1 - Global health actors no longer in favor of user fees: a documentary study. Emilie Robert and Valéry Ridde
http://www.globalizationandhealth.com/content/9/1/29/abstract - Changes to health funding and church health service provision in low- and middle-income countries. Ascroft et al.
http://ni.unimelb.edu.au/__data/assets/pdf_file/0005/804704/WP_31.pdf - Addressing ethical, social, and cultural issues in global health Research. James V. Lavery et al.
http://www.plosntds.org/article/info%3Adoi%2F10.1371%2Fjournal.pntd.0002227
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Universal health coverage
- The many paths towards universal health coverage. WHO video
http://www.youtube.com/watch?v=VQ3sHfYzcv8&feature=youtu.be - Universal health coverage and universal access. David B Evans, Justine Hsu and Ties Boerma in: WHO Bulletin
http://www.who.int/entity/bulletin/volumes/91/8/13-125450/en/index.html - Post-2015 African Health Agenda and universal health coverage: Call for Abstracts
https://afhea.confex.com/afhea/intl14/cfp.cgi - Universal Health Coverage Forum, 26-27 August 2013, Bonn, Germany
http://goo.gl/XWjPgb - Universal financial protection: Thai universal coverage scheme designed to ensure equity Tangcharoensathien et al.
http://www.health-policy-systems.com/content/11/1/25
MMI events and resources: see above
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Human resources for health
Migration of health professionals
- Human Resources for Health: Make them part of Global Governance for Health discussions. Richard Seifman
http://bit.ly/16FnaPi - Human resource development for a community-based health extension program: a case study from Ethiopia
http://hesp-news.org/?p=5895 - Association between health worker motivation and healthcare quality efforts in Ghana. Robert Kaba Alhassan et al.
http://www.human-resources-health.com/content/11/1/37/abstract - Consultation on Human Resources for Health for high income countries. Oslo, 5 September 2013
http://www.who.int/workforcealliance/media/news/2013/osloconsultation/en/index.html - Strengthening the health workforce & rolling out universal health coverage: the need for policy analysis. Koon/Mayhew
http://uhcforward.org/sites/uhcforward.org/files/GHA-6-21852.pdf - PEPFAR, career choices and emigration of health-profession graduates from a Ugandan medical school. Bajunirwe et al.
http://bmjopen.bmj.com/content/3/5/e002875.full.pdf - The financial cost of doctors emigrating from sub-Saharan #Africa: human capital analysis
http://www.bmj.com/content/343/bmj.d7031
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Access to medicines and vaccination
Medical research and development
Neglected diseases
- WHO Good Governance for Medicines Model Framework 2012. Draft for public comment (until October 2013)
http://www.who.int/medicines/areas/policy/goodgovernance/ggm_modelframe2012/en/index.html - WHO Technical Briefing Seminar on Essential Medicines Policies and Programmes. Geneva, 28 October – 1 November 2013
http://www.who.int/medicines/technical_briefing/tbs/en/index.html
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Women’s and children’s health
Sexual and reproductive rights and health
- Advancing maternal survival in the global context: are our strategies working? Omar A Khan et al.
http://www.biomedcentral.com/1471-2458/13/689 - Ending preventable maternal deaths: the time is now. Flavia Bustreo et al.
http://www.lancet.com/journals/langlo/article/PIIS2214-109X%2813%2970059-7/fulltext - Measuring maternal health: focus on maternal morbidity. Tabassum Firoz et al. in: WHO Bulletin (online first)
http://www.who.int/bulletin/online_first/13-117564.pdf
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Noncommunicable diseases
Mental health
- WHO Global Action Plan for the Prevention and Control of Non-communicable Diseases 2013-20 adopted in May 2013
http://apps.who.int/gb/ebwha/pdf_files/WHA66/A66_R10-en.pdf - WHO Global Action Plan: A milestone in the response to non-communicable diseases. Oleg Chestnov et al.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61457-9 - Set of indicators for the WHO Global #NCD Action Plan 2013-2020. WHO online consultation, Aug-Oct 2013
http://www.who.int/nmh/events/action_plan_indicators/en/index.html - How trade agreements affect health: Trade Agreements and Non-communicable Diseases in the Pacific Islands
http://www.who.int/nmh/events/2013/trade_agreement.pdf - “The Global Challenges of Noncommunicable Diseases” – New PLOSMedicine Collection
http://www.ploscollections.org/noncommunicablediseases - Salt, sugar, fat: addictive stuff. Remco van de Pas on a WHO nutrition and NCDs conference
http://e.itg.be/ihp/archives/salt-sugar-fat-addictive-stuff/#sthash.61FrxI7v.dpuf - NCDs: Global health priority or market opportunity? WHO at its worst and at its best. Alison Katz (no free access)
http://baywood.metapress.com/app/home/contribution.asp?referrer=parent&backto=issue,4,13;journal,1,171;linkingpublicationresults,1:300313,1 - The politics of reducing malnutrition: building commitment and accelerating Progress. Stuart Gillespie et al.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)60842-9 - Building back better: Sustainable mental health care after emergencies. WHO 2013
http://apps.who.int/bookorders/anglais/detart1.jsp?codlan=1&codcol=15&codcch=854 - What evidence do we need to design better mental health interventions in conflict zones?
http://buff.ly/14bl9Wu
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Equity and human right to health
Social determinants of health
Poverty and social protection
- The economics of the social determinants of health and health inequalities. A resource book. WHO 2013
http://apps.who.int/bookorders/anglais/detart1.jsp?sesslan=1&codlan=1&codcol=15&codcch=856 - Handbook on health inequality monitoring – with a special focus on low- and middle-income countries. WHO 2013
http://apps.who.int/bookorders/anglais/detart1.jsp?codlan=1&codcol=15&codcch=857 - The struggle for health. International People’s Health University (with first sessions on YouTube)
http://www.phmovement.org/en/node/7709 - Health, social injustice and global action – reflections from the Lancet Commission chair Ole Petter Ottersen
http://www.med.uio.no/helsam/english/research/global-governance-health/news/reflectionschair.html
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Global health governance and policy
WHO reform
NGO debate
- “Multilateralism-lite” might miss the big picture. Amanda Glassman
http://www.cgdev.org/blog/multilateralism-lite-might-miss-big-picture-0 - Ministerial Forum of China-Africa Health Development: Beijing Declaration (English: scroll down!)
http://www.moh.gov.cn/gjhzs/s3590/201308/da8ad62e487a481f987e631e1318c6fc.shtml - The European health report 2012: charting the way to well-being:
http://www.euro.who.int/en/what-we-publish/abstracts/european-health-report-2012-charting-the-way-to-well-being-the - The new global health. Kevin M. De Cock et al.
http://wwwnc.cdc.gov/eid/article/19/8/13-0121_article.htm?s_cid=eid-gDev-email - Public engagement in health priority setting in LMIC: Trends and considerations for policy. Bolsewicz Alderman et al.
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001495 - WHO reform: A personal perspective. Ilona Kickbusch
http://hesp-news.org/2013/07/30/who-reform-a-personal-perspective/ - Charity CEOs’ pay: let’s talk about transparency. Michael Jennings
http://www.theguardian.com/global-development/poverty-matters/2013/aug/06/charities-ceo-pay-transparency-ngos - If you pay charity bosses peanuts you’re going to get monkeys. Duncan Green contributes to a hot UK debate
http://www.theguardian.com/commentisfree/2013/aug/08/pay-charity-bosses-ngo-executives
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Health beyond 2015
MDGs and SDGs
- A Life of Dignity for All. Report of the UN Secretary-General on MDGs and post2015, 26 July 2013
http://www.un.org/ga/search/view_doc.asp?symbol=A/68/202 - Health in the Post-2015 Development Agenda. WHO analysis of consultation process, July 2013
http://apps.who.int/iris/bitstream/10665/85535/1/9789241505963_eng.pdf - Memo to the UN: accountability is key to effective development Goals. Thomas Pogge and Mitu Sengupta
http://www.theguardian.com/global-development/poverty-matters/2013/aug/20/un-development-goals - Post-2015 African Health Agenda and universal health coverage: Call for Abstracts
https://afhea.confex.com/afhea/intl14/cfp.cgi - Keep value of the MDGs and address their shortcomings – challenge of health #post2015. Kumanan Rasanathan
http://bit.ly/18QJFRh - A UN Declaration on the Post-2015 Development Agenda. “Essay” (proposed statement) by Charles Kenny
http://www.cgdev.org/sites/default/files/un-declaration-post-2015-development-agenda.pdf
- SDGs, MDGs and post-2015 Development Agenda: Questions and answers
http://www.sustainabledevelopment2015.org/index.php/uncsd-official-docs/frequently-asked-questions - New health goal for humanity, and global social contract: Realising the right to health for everyone. V.Leemput/Ooms
http://e.itg.be/ihp/archives/health-goal-humanity-global-social-contract-realising-health/
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