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Can the Astana Declaration Be a Turning Point to Finally Ensuring Primary Health Care for All?

This guest post was originally posted on the Frontline Health Workers Coalition website. The post was written by Vince Blaser, Director, Frontline Health Workers Coalition and Senior Advocacy and Policy Advisor, IntraHealth International. The Frontline Health Workers Coalition is an alliance of United States-based organizations working together to urge greater and more strategic investments in frontline health workers in low- and middle-income countries as a cost-effective way to save lives and foster a healthier, safer, and more prosperous world.

Frontline Health Workers Coalition Director Vince Blaser asks a question of panelists at the ministerial session on health workforce at the Global Conference on Primary Health Care in Astana, Kazakhstan. Photo courtesy IntraHealth International. Image courtesy: Frontline Health Workers Coalition

Fellow delegates to last week’sGlobal Conference on Primary Health Care in Astana, Kazakhstan, have flown home to an awesome yet daunting challenge: 40 years after the landmark Alma-Ata Declaration of 1978 declaring health as a human right, how can we finally make the declaration’s vision of primary health care (PHC) for all a reality?

The monumental 1978 conference in Alma-Ata, USSR (now Almaty, Kazakhstan) pronounced for the first time global agreement that health is a “fundamental human right” and called for “urgent and effective national and international action to develop and implement primary health care throughout the world.”  Representatives from 134 countries broke across political and ideological differences, personally urged on by the likes of the late US Senator Ted Kennedy, and set a target to achieve PHC for all by 2000.

Forty years later we’ve come a long way, but are far from reaching the dream hatched in Alma-Ata.

Last Thursday, 1,200 delegates from more than 120 countries renewed the commitment to PHC for all with the Astana Declaration. More than 180 civil society organizations, including the Frontline Health Workers Coalition, through the UHC2030 Civil Society Engagement Mechanism signalled our intent to see PHC for all finally realized and what it will take to get us there.

Here are three factors I believe will be critical to achieving the Astana Declaration.

Learn from the past and build on progress made

The evidence and political will behind the Millennium Development Goals and major annual increases in development assistance for health in the 2000s gave rise to progress on many of the top issues in public health: annual deaths of children under 5 more than cut in half and maternal deaths nearly cut in half since 1990, almost a 50% decline in annual deaths from HIV since 2005, and deaths from malaria down 63% from 2000-2015.

But, as World Health Organization Director-General Tedros Adhanom Ghebreyesus noted in his opening remarks in Astana, progress has not been equitable. The people whose lives have been saved and made healthier have largely been the easiest to reach.

Following the Alma- Ata Declaration, many countries took action to increase access to PHC, including efforts to usher in CHW programs focused on the areas of least access. Unfortunately, large-scale CHW programs of the 1980s and 1990s largely failed due to a variety of factors, according to leading scholars like Henry Perry of Johns Hopkins University. But now, many countries, global initiatives, and donors are looking to scale up community health worker (CHW) programs to address the gaps in primary health care access.

Last Friday in Astana, the WHO released its first-ever guidelines to optimize the effectiveness of CHW programs. In the last two decades, CHW programs of all shapes and sizes have been tried and researched, many of which have been supported in some way by the US and other development assistance donors and implemented or supported members of the Frontline Health Workers Coalition. This evidence has been put to use in some countries’ development of CHW programs—but the release of these guidelines, backed by this evidence, will provide adaptable recommendations for all countries to utilize.

Central to the success of CHW programs, according to the guidelines, will be how well they are integrated into the health system, especially national health workforce plans. The message that permeated several panels in Astana, made clear by frontline health workers like Maria ValenzuelaMunashe Nyika, and Ruth Tarr, was that teams of well-supported frontline health workers with the education, training, equipment, information, and support they need, are required to deliver PHC for all.

Be unequivocal about the task ahead

A major factor in the progress made in global health was the solidarity, leadership, and leverage that came with the average annual increase of more than 10% in development assistance for health from 2000-2010. Unfortunately, that assistance has levelled off, averaging a 1% increase since 2010 and decreasing slightly from 2016 to 2017, according to the Institute for Health Metrics and Evaluation. At the same time, average domestic spending on health in low-income countries decreased from 1.69% of GDP in 2006 to 1.44% in 2015, according to Save the Children.

While overall global spending on health continues to grow, investment has not been focused on providing quality primary care to communities of least access and, as a result, health inequities are exacerbated. The new report of the Lancet Global Health Commission on High Quality Health Systems in the SDG Era found over 8 million people die annually in low- and middle-income countries (LMICs) because of “inadequate access to quality care,” resulting in $6 trillion in economic losses.

The laudable goal of quality PHC for all set forth in the Astana Declaration cannot be achieved without far greater global solidarity to focus and invest in communities of least access to quality health services in LMICs. This means greater investment in these communities by development assistance donors, greater investment by LMICs themselves in PHC, and greater investment from the philanthropic and private sector, especially in the areas where long-term investment is most needed, such as health workforce education and addressing gender inequities.

Be bold and concrete in political commitments

Although the Astana Declaration lays out the solidarity of commitment to the right of health for all enshrined in the Alma-Ata Declaration and the desire to achieve it, the specific commitments needed to make this vision a reality were as absent last week as they were in 1978.

Thankfully, the framework for what needs to be achieved is there on paper, waiting for bold, sustained action to be taken.

The goal of achieving universal health coverage or UHC, unanimously agreed to by United Nations member states in 2012, has itself become a driving force for achieving health for all. The opportunity is ripe for concrete commitments to realize the Astana Declaration at the UN High-Level Meeting on UHC in September 2019 in New York.

In the arena of health workforce, where FHWC focuses our advocacy, the blueprint of what must be committed to next year in New York needs better data to deliver better investment.

FHWC’s recommendations are clear: we will need a heavy dose of political will in the form of bold new financial and programmatic commitments, as will other core components of PHC and UHC.

Last week we celebrated the vision for PHC for all enshrined in the Alma-Ata Declaration 40 years ago but lamented our failure to reach its vision. Forty years from today, I hope we celebrate this week in Astana as the starting point for bold actions that made that vision a reality.


Delivering Quality Care to Patients Who Need it Most: Exploring Health Strategies at the Global Conference on Primary Health Care

This blog post was written by Maia Olsen, Program Manager, NCD Synergies at Partners In Health (PIH). PIH’s mission is to provide a preferential option for the poor in health care. By establishing long-term relationships with sister organizations based in settings of poverty, Partners In Health strives to achieve two overarching goals: to bring the benefits of modern medical science to those most in need of them and to serve as an antidote to despair. They are a 2018 Global Health Council member.

Maia Olsen (second from the left) joins PIH colleagues in Astana, Kazakhstan – including PIH Liberia’s Executive Director Patrick Ulysse, PIH Haiti’s Co-Executive Director Loune Viaud, and PIH’s Senior Director of Strategic Partnerships Leslie Flinn – in a surprise photo with WHO Director General Tedros Adhanom Ghebreyesus, who was between commitments amid a busy conference schedule. Photo Credit: Eric Hansen / Partners In Health

Last week, Partners In Health (PIH) came together in Astana, Kazakhstan with Ministries of Health and colleagues representing institutions throughout the world for a historic and inspiring week of meetings on primary health care and strategies to achieve Universal Health Coverage (UHC). The week was in honor of the 40th Anniversary of the Declaration of Alma-Ata, as well as in recognition of how much is still left to be achieved on the 1978 call to action so many years ago.

On Wednesday 24th October, PIH held a one day pre-meeting to the global conference entitled “Health Systems and Delivery Strategies to Achieve Universal Health Coverage” in collaboration with the Ministry of Health of Kazakhstan and the Global Financing Facility. At this meeting, PIH looked to generate energy and critical discussion around pathways to expand quality care delivery to patients who need it most, across all levels of the health system. A common theme throughout the day’s discussion was how imperative it is that we – as the implementing community in low- and middle-income countries – encourage donors and support governments to invest in comprehensive health systems strengthening that addresses what our patients need across the full disease spectrum, rather than centering prevention and care delivery solely around “low-hanging fruit”, vertical programs, or a more minimal and selective primary care package.

Over 150 participants attended PIH’s sessions, representing peer organizations such as PIVOT, Muso, Possible, Last Mile Health, Integrate Health, Amref, and many members of the Frontline Health Workers Coalition and Civil Society Engagement Mechanism for UHC2030, prominent stakeholders including the WHO, World Bank, Global Fund, USAID, GAVI, and Global Health Council, and more than ten Ministry of Health delegations across countries as diverse as Liberia, Madagascar, Kazakhstan, and Nepal. Throughout the day, discussions were forward-looking, social justice focused, and rooted in asking hard questions regarding how to provide increased access to quality care to the world’s most vulnerable populations.

As Dr. Joia Mukherjee, PIH’s Chief Medical Officer, stated in an opinion piece coinciding with last week’s conference:

“Provision of high quality care is attainable in some of the hardest to reach and least-resourced settings when patient-centered approaches are prioritized […] Universal health coverage is an ideal whose benefits are clear, whose time has come, and whose expense is nothing compared to the cost of continued delays.”

As someone representing the NCD community through my role with the NCD Synergies program at PIH and who has closely collaborated with partners like the Global Health Council, NCD Roundtable, and the Women and NCDs Taskforce in advocacy efforts leading up to the 2018 UN High-Level Meeting on NCDs, it was inspiring to be – just over a month later – in a room where NCDs, mental health, and injuries fit squarely in a broader conversation around how to achieve universal health coverage and health financing in the poorest settings where PIH works.

As we have demonstrated through PIH’s work and partnership across the Program in Global NCDs and Social Change at Harvard Medical School and the Lancet Commission on Reframing NCDs and Injuries among the Poorest Billion, there are proven strategies to address gaps in care for NCDs, mental health, and surgically-amenable conditions, which often extend beyond primary care, such as the PEN-Plus packagefor integrated management of severe, complex, and chronic NCDs such as rheumatic heart disease and type 1 diabetes at first-level hospitals.

For those that have seen or experienced the struggles of young patients like Babesh Tumang and Sheila Chipenge living with NCDs like neuroblastoma and type 1 diabetes, it is immediately clear why severe NCDs that impact the world’s youngest and poorest patients must be included as an essential part of the global UHC agenda. Their voices are why our NCD Synergies team made the call to action we did on behalf of PIH at the July 5th United Nations Interactive Hearing on NCDs alongside our colleagues at Global Health Council and other civil society institutions.

Their voices are also why we were so honored to be in Astana to come together around such an ambitious call to action to support governments to progressively achieve universal coverage to quality care spanning the health system and inclusive of all conditions – from cholera to multi-drug resistant tuberculosis to rheumatic heart disease.

We ask our colleagues throughout the world to join forces with us in advocating for increased funds for integrated health systems strengthening to achieve UHC. Let’s work together to realize the commitments in the Astana Declaration – and throughout the UHC agenda – in a way we didn’t following Alma Ata in 1978.

As Americans vote, what does it mean for global health?

This post was originally posted on PATH’s website and was written by Carolyn Reynolds, Vice President of Policy and Advocacy at PATH. PATH is a global team of innovators working to accelerate health equity so all people and communities can thrive. They are a 2018 Global Health Council member.

As the midterms approach, there’s a lot at stake for those of us who care about global health and development. Control of the Senate will depend on just nine “toss-up” seats. All 435 seats in the House of Representatives are up for grabs, but only a small number, a net gain of 24 seats, are needed to change the majority. Add in the fact that a number of our prominent global health and development champions are retiring—such as Dave Reichert (R-WA), who chairs the Congressional Global Health Caucus, and Bob Corker (R-TN), who chairs the powerful Senate Foreign Relations Committee—and it’s no wonder many in our community are concerned that US support for these critical programs could be in jeopardy.

However, there’s still hope. There are two simple things worth remembering:

First, saving lives and improving health around the world is a bipartisan US priority.

From preventing hunger and the spread of deadly diseases to expanding access to girls’ education, women’s health care, and childhood nutrition and immunization, tremendous progress has been made in global health and development with the support of the American people.

For instance, because of American investments in the President’s Emergency Plan for AIDS Relief since 2003, more than 2.2 million babies at risk of HIV in Africa have been born free of HIV, and millions of AIDS orphans and vulnerable children have received compassionate care and support. A US-supported malaria program, the President’s Malaria Initiative, is another success story. It has helped cut the number of malaria cases globally by 37 percent and malaria deaths by 60 percent since 2000. Support for both these global programs has remained strong over the years throughout shifts in control of Congress and the White House—because they work, they reflect our humanitarian values, and they engender tremendous goodwill for America.

As compared to just two decades ago, more Americans today understand that foreign assistance is not a “handout” but rather it advances US interests. American businesses and global nongovernmental organizations (NGOs) such as PATH are working with the US government to support these programs and to continue to transform the way we deliver aid through innovation. Congress’ recent passage of the BUILD Act, a bill that will catalyze private-sector investments to drive global development impact—is the newest chapter in America’s 70-year-plus continuing commitment to improving the health and well-being of people around the world—whether it’s saving lives, improving access to safe drinking water, preventing blindness, and so much more.

And it’s not just about improving health. As evidenced by recent US efforts to improve a country’s ability to prevent, detect, and respond to public health threats, investments in global health and development can also help cultivate new markets for American products and services. They can protect and promote demand for exports that support millions of US-based jobs in sectors such as agriculture and manufacturing—jobs that are critical to America’s economic well-being.

Second, advocacy matters.

While the outcome of the midterms won’t be clear until polls close on November 6, what we do know is this: whether they are returning for another term or arriving in DC for the first time, legislators are influenced by what they hear from their constituents. Back in 1994 when the US faced another “wave” election, there was almost no national grassroots constituency for foreign assistance programs outside the US Capital Beltway. Now as a result of persistent advocacy efforts from groups like PATH working together with our NGO and business partners in coalitions such as the US Global Leadership Coalition, today there are strong and growing numbers of vocal supporters for US foreign assistance in all 50 states. At the same time, with so many competing domestic priorities, we can’t take this support for granted.

So as the new Congress takes shape and prepares to lead in 2019, we must also get to work. Those of us who understand and care about the impact of US leadership in the world must engage with our elected officials and the people they represent, to make the case for continued US investments in global health and development—for a better and healthier world, and a safer and more prosperous America.

Global Health Council (GHC) will be navigating these political landscape discussions further at the 2018 Global Health Landscape Symposium, where GHC member PATH will also engage. Register today to join GHC  in Washington, DC on November 30, 2018.

IMA World Health Builds on Successes Against Burkitt’s Lymphoma in Tanzania

This blog post was written by Emily Esworthy, Communications Officer at IMA World Health, as part of GHC’s Member Spotlight Series. IMA’s mission is to build healthier communities by collaborating with key partners to serve vulnerable people. IMA World Health is a 2018 Global Health Council member.

Selemani Hamij is a quiet and thoughtful 4-year-old boy who was looking forward to his birthday in September. While most kids get excited about birthdays, it’s even more of a milestone for Selemani.

In January, he started complaining of pain in his mouth, and his mother saw that his gums appeared to be inflamed. She took him to a health center near their home in Kihaba, Tanzania, for treatment. There, health workers said they could treat the tooth, but they had to wait until the inflammation went down. “But the inflammation didn’t go down,” Selemani’s father, Hamis Omary Nyandikira, said.

Selemani Hamij was experiencing increasing swelling in his gums when he was admitted to Muhimbili’s pediatric cancer ward, which led to his diagnosis of Burkitt’s Lymphoma. (Photo courtesy of TLM.)

In March, when local treatment options failed to ease his pain and swelling, Selemani was referred to Muhimbili Hospital in the capital city of Dar es Salaam and was admitted to the dentistry ward. Again, treatment didn’t work; the swelling in his mouth grew, and Selemani was growing weaker by the day. That’s when health workers realized Selemani didn’t have a problem with his tooth: he had Burkitt’s Lymphoma or BL, an aggressive but treatable childhood cancer. He was transferred to Muhimbili’s pediatric oncology ward on March 22, into the care of Drs. Jane Kaijage and Trish Scanlan.

Angels of Oncology

IMA World Health has supported BL programs in Tanzania since 2001, working to advance treatment guidelines, train health workers on diagnosis and case management and provide treatment for over 4,500 children like Selemani. Today, IMA is pleased to partner with and support the work of these two visionary women who run Muhimbili’s pediatric oncology ward.

In Dr. Scanlan’s words, Dr. Kaijage is the “Founder of Pediatric Oncology in Tanzania.” She single-handedly ran Tanzania’s first pediatric cancer program at Ocean Road Cancer Institute from 2004 to 2007, and her work was instrumental in dramatically increasing the survival rates for BL patients from 10 percent to 75 percent in just two years.

Dr. Scanlan, an Irish pediatric oncologist, came to Tanzania to work with Dr. Kaijage at ORCI in 2007. In 2011 they moved operations to Muhimbili National Hospital, where they would have more space and resources, including access to specialists, surgeons, and CT and MRI machines to further advance the quality of care they could provide to the children. That year, Dr. Scanlan founded Their Lives Matter/Tumaini la Maisha or TLM, a nonprofit organization that works within and alongside Muhimbili’s pediatric oncology ward to fill gaps in both clinical and non-clinical services for patients and their families—from chemotherapy drugs and nutrient-rich smoothies to housing during treatment and educational programs for children and parents. In total, they treat about 500 new children for various cancers every year.

Quick Results

Today, Selemani is completing his treatment for BL and feeling healthy and strong. (Photo by Jennifer Bentzel/IMA World Health.)

Under the care of Dr. Kaijage, Dr. Scanlan and hospital staff, Selemani began chemotherapy immediately. As with most patients, Selemani and his father lived on the ward during the most intensive parts of treatment—for some families, that can last as long as a year. After six weeks, Selemani’s tumor was gone, and at the beginning of May he was able to go home. He returns to the hospital weekly for treatments, but today he is feeling much stronger and healthier and is expected to make a full recovery.

Looking Ahead

BL is associated with malarial infection, and thankfully its numbers are declining. “We are seeing less and less BL because the campaign against malaria is working,” Dr. Scanlan explained. And though BL progresses quickly and is fatal without treatment, increased awareness and availability of proper treatment has led to increasing rates of survival over the years.

For this reason, IMA is continuing to support treatment for children with BL, but we are also expanding our reach to other childhood cancers in concert with TLM and Muhimbili National Hospital.

Selemani’s father, Hamis Omary Nyandikira, says he is very happy with his son’s treatment and recovery after several months of scary and life-threatening symptoms. (Photo by Jennifer Bentzel/IMA World Health.)

“For over 17 years, IMA and our donors have contributed to very notable accomplishments in the treatment of Burkitt’s Lymphoma in Tanzania in various ways,” IMA President and CEO Rick Santos commented. “Engaging with TLM and Muhimbili means that we can leverage these successes to reach more children who need it most.”

TLM has ambitious goals that IMA is eager to support. Currently, TLM is working to empower the referral network in Tanzania by training regional hospitals in early diagnosis—still the number one challenge to survival rates—and by building the capacity for local treatment options so that families do not have to travel so far, or be separated for so long, during a child’s treatment.

Dr. Scanlan sums up TLM’s strategic plans by saying, “Our vision: get to every child.” IMA looks forward to partnering with TLM as we continue to work toward our own vision of health, healing and well-being for all.

Looking Toward the Future: Innovation for Global Health Impact

This blog post was written by Emily Kiser, Program Manager, Triangle Global Health Consortium. The Triangle Global Health Consortium is a non-profit member organization representing institutions and individuals from the pharmaceutical and biotechnology industry, the international health development NGO community, the faith community, and academia.  The Consortium’s mission is to establish North Carolina as an international center for research, training, education, advocacy and business dedicated to improving the health of the world’s communities. They are a 2018 Global Health Council member.

Image courtesy: Triangle Global Health Consortium

On September 27, more than 300 global health professionals and students gathered in Raleigh, North Carolina to explore innovation for global health impact at the 2018 Triangle Global Health Annual Conference, hosted by the Triangle Global Health Consortium (TGHC).  Each year, the Triangle Global Health Annual Conference highlights the incredible global health work taking place in North Carolina and its far-reaching impacts.

The day featured dynamic keynote addresses from Dr. Timothy Mastro, Chief Science Officer at FHI 360, and Dr. Ticora V. Jones, Director for the Center for Development Research and Division Chief for the Higher Education Solutions Network (HESN) within the US Global Development Lab at USAID.

Plenary panel discussions delved into embedding social innovation to drive gender equality and accelerating and scaling global health innovation. As TGHC’s Executive Director, Jacob Traverse, noted, “When you’re dealing with global health issues, particularly in developing regions, often the challenge isn’t so much [medical technology], but it’s how you integrate these layers of the community and deal with cultural dynamics that may go back generations. There’s always inspiration in these discussions.”  

Additional panel and workshop sessions throughout the day spanned a wide range of innovation topics including digital health, medical transport via drones, innovations in M&E, innovative funding models, and more. Participants had the opportunity to address hypothetical outbreak scenarios, explore and create new cervical screening methods, engage in ideation, and – most importantly – collaborate and connect with other participants across organizations and sectors.

As one 2018 conference participant shared, “[TGHC] brings together so many of the great organizations, people and knowledge that exist here in the Triangle, and taps into regional resources that extend beyond our immediate network. It is a gem in our global health community here and really brings to life a thriving, vibrant industry in North Carolina.”