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Polio Transition – A Missed Opportunity on the path towards UHC?

This guest post was originally posted on the RESULTS website and was written by Laura Kerr, Senior Policy Advocacy Officer (Child Health), RESULTS UK, and a member of the Gavi CSO Constituency Steering Committee. RESULTS is a movement of passionate, committed, everyday people. Together we use our voices to influence political decisions that will bring an end to poverty.

How are we going to achieve Universal Health Coverage (UHC)? This is the focus of this year’s World Health Assembly (WHA) taking place in Geneva from May 21st-26th. Since taking office, the World Health Organization (WHO) Director-General, Dr. Tedros, has set out ambitious objectives as part of the WHO’s 13th General Program of Work.  Known as the Triple Billion Targets, he ambitiously wants to ensure 1 billion more people benefit from UHC, 1 billion more people are better protected from health emergencies, and 1 billion more people enjoy better health and well-being.

Photo: Tom Maguire/RESULTS UK

But can we, and will we, achieve these objectives when only 7% of children in the world’s poorest countries receive all 11 WHO recommended vaccines? Out of all health services, immunisation does have one of the highest global coverage rates but when 1 in 10 kids still receive no vaccines, it is clear we are still too far from universal coverage of this essential service. Routine immunisation drives an equitable approach to health services, but these need to be urgently strengthened if we are to reach the Sustainable Development Goals (SDGs) and the Triple Billion targets.

This year’s WHA could be a defining moment for immunisation. With an agenda item on polio transition up for review by Member States, leadership and ambition could turn a situation with great potential risk into one that leaves a positive legacy on child and global health; but this will only happen if the WHO and Member States act now.

The Global Polio Eradication Initiative (GPEI), of which WHO is one of five core partners, is a $1billion a year partnership which was set up to eradicate polio. As we near that end goal, the GPEI is winding down, completely ending when polio is eradicated. The WHO is presenting to Member States this week their plan for what comes next after the GPEI winds down, in some countries in 2019.

The draft WHO Strategic Action Plan on Polio Transition lays out what the WHO will do to ensure the world remains polio-free after the wind down of GPEI and that the objectives set out in the polio end-game strategy are reached. This plan is just one piece of the global process of polio transition, but as it stands, it lacks the details, ownership, and aspiration needed to drive transformative change for immunization and health systems.

There are three main ways in which the WHO Strategic Action Plan could be improved to take advantage of this unique situation:

1) Focus on essential immunization coverage:
  the WHO needs to set out more clearly how they will strengthen routine immunization systems

2) Confirm coordination mechanisms: There needs to be a clear coordination mechanism in place to guide the implementation of WHO’s strategic action plan at global, regional and national levels otherwise it just won’t happen. It is not enough to set out what needs to happen at this stage, we urge concrete plans be put in place before the plan is implemented.

3) Set out clear financial requirements: There are large assumptions in the plan around future financing but at this stage, it is very unclear where funds are guaranteed and where they will and can come from. We also don’t know the extent of Gavi, the Vaccine Alliance’s role in supporting various elements of polio transition.  Increased clarity of current fundraising expectations and gaps at a country, regional and global level, for the WHO Plan and the Post-Certification Strategy, is critical.

With funding from GPEI ending in all except polio-endemic countries in 2019, the window of opportunity is small. The current version of the plan leaves too many unanswered questions, especially how it will be operationalized. You can read our full recommendations for improving the plan here.

WHO leadership and ownership of essential elements of the transition process going forward is essential; without their guidance, the risks for polio transition being a missed opportunity are just too high.

If we are to reach UHC in all countries, we need ambition, innovation, and to proactively seek new ways of tackling barriers to healthcare. Polio transition provides us this opportunity. All we need to do is take it.

The Local Path to Global Health Security

This article was originally published in Global Health NOW.  The article is around a WHA side-event organized by Global Health Council & partners. Global Health NOW has gathered thousands of subscribers worldwide who rely on it as a source for their global health news. The mobile-ready website came online in March 2015, delivering more exclusive stories and commentaries, breaking news, and news summaries. To follow the #healthsecurity conversations online, follow @GlobalHealthOrg on Twitter.

The Global Fund’s Peter Sands speaking at a #WHA71 side event in Geneva on May 22, 2018. (Image by Brian W. Simpson, Global Health NOW)

Global Fund executive director Peter Sands set an ominous challenge before experts at a Monday side event of the World Health Assembly: “The number of infectious disease outbreaks is going up,” Sands said. “This is not a problem that is going away as mankind gets bigger and richer. This is a problem that seems to be increasing in magnitude.”

The challenge is to recognize the cost of epidemics and prepare locally in advance, he told an audience at the “Getting Local with Global Health Security” event sponsored by Management Sciences for Health, the Global Health Council and others. The costs in human lives and in dollars should drive better preparedness, Sands argued, citing an estimated $500 billion per year in economic and human costs.

“This is a phenomenon with a significant economic impact,” he said. Drawing on his experience in the financial industry in Hong Kong, Sands noted the 2003 SARS outbreak cut tourism there by two-thirds 2 months afterwards.

“We live in a world where fear travels extremely fast,” he said. The result is massive changes in personal behavior resulting in impacts that can shake national economies.

Preparing in advance is more effective than trying to respond afterwards. And the key to preparation, explained Tom Frieden, President and CEO of Resolve to Save Lives, is for each country to know its weaknesses and fix them.

Frieden then displayed a slide covered in green, yellow and red squares that chart countries’ preparedness status across the 76 indicators of the Joint External Evaluation. The evaluation is meant to provide a gauge of how countries are doing in meeting targets that are in the 2005 International Health Regulations.

While acknowledging the JEE’s intimidating detail—it looks like a block by block heat map of a sprawling metropolis—he drilled down into the chart and surfaced advances in preparedness that Sierra Leone achieved in just 6 months in 2016. Tanzania scored similar wins from 2016 to 2017, Frieden said.

“This is the kind of focus that we are going to need if we’re going to make progress against epidemics,” he said.

Diane Gashumba, Minister of Health of Rwanda, found JEE to be a helpful exercise. Essential to the process is being transparent and open about your country’s weaknesses. If that’s not embraced from the start, the process is destined to fail, she said.

Each country has to adapt global health security work to its own specific situation, Gashumba said. “Sometimes it is very difficult to make priorities especially when you have a lot of health and social issues,” she said. “In my country, Rwanda, the strategy we adopted is to focus everything on the ground because the issues are on the ground but also the solutions are on the ground.”

Sands noted the issue with JEE is that more countries have done the assessment of their capacity than “have actually closed the gaps.” The Global Fund, he noted, too, has room for improvement. It can do a better job making sure that the hundreds of millions of dollars supporting AIDS, TB and malaria efforts can do double duty by more broadly helping countries prepare for future epidemics. “I think we have a bit too much-siloed language and thinking,” he said.

Rüdiger Krech, director of Health Systems and Innovation at WHO, said the preparedness for epidemics is within any country’s reach. “First of all, it is a political choice,” Krech said. “By and large know what to do. It’s not that we can’t afford it. We can afford it. That is why it’s a political choice.”

The challenge is to persuade government leaders preparedness is worth the price tag.

GHC Statements to WHA71

This post will be updated regularly. Please check back in to stay informed. Follow @GlobalHealthOrg on Twitter for instant updates!

Dr. Tedros Adhanom Ghebreyesus addresses the  71st World Health Assembly on Monday, May 21, 2018.

On Monday, May 21, the 71st World Health Assembly (WHA71) began at 9:30 AM CET.

Topics to be covered at WHA71 include the 13th General Programme of Work (GPW13), WHO’s work in health emergencies, polio, physical activity, vaccines, the global snakebite burden and rheumatic heart disease.

Although the Assembly just opened today, statements from the GHC delegation are already making their way onto WHO’s Non-state actors’ statement portal. After being published online and following the item’s discussion by Member states, GHC delegates will have an opportunity to read these statements on the floor of WHA.

View GHC’s joint statements below (more to come soon):

1) Agenda Item 11.1: Draft thirteenth general programme of work, 2019–2023: View the joint statement from Global Health Council, supported by ACTION Global Health
Advocacy Partnership and Pathfinder International.

2) Agenda Item 11.2: Public health preparedness and response: View the joint statement from Global Health Council, supported by American Academy of Pediatrics, Infectious Diseases Society of America (IDSA), & Management Sciences for Health (MSH).

3) Agenda Item 11.3: Polio transition and post-certification: View the joint statement from Global Health Council, supported by ACTION Global Health Advocacy Partnership.

4) Agenda Item 11.4: Health, environment, and climate change: View the joint statement from Global Health Council, supported by NCD Child and Pathfinder International.

5) Agenda Item 11.5: Addressing the global shortage of, and access to, medicines and vaccines: View the joint statement from Global Health Council, supported by American Academy of Pediatrics (AAP), NCD Child, International Federation of Psoriasis Associations (IFPA), and Global Health Technologies Coalition.

6) Agenda Item 11.6: Global strategy and plan of action on public health, innovation and intellectual property: View the joint statement from Global Health Council, supported by Infectious Diseases Society of America (IDSA).

7) Agenda Item 11.7: Preparation for the third High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases, to be held in 2018:  View the joint statement from Global Health Council, supported by American Academy of Pediatrics (AAP), NCD Child,  International Federation of Psoriasis Associations (IFPA), RTI International, and Partners in Health (PIH).

8) Agenda Item 11.8: Preparation for a high-level meeting of the General Assembly on ending tuberculosis: View the joint statement from Global Health Council, supported by the Infectious Diseases Society of America, the Elizabeth Glaser Pediatric AIDS Foundation, the Global Health Technologies Coalition and Partners in Health.

9) Agenda Item 12.2 Physical activity for health: View the joint statement from Global Health Council, supported by AAP, NCD Child, and RTI International.

10) Agenda Item 12.3: Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030): sexual and reproductive health, interpersonal violence, and early childhood development: View the joint statement from Global Health Council, supported by Living Goods, the American Academy of Pediatrics, Pathfinder International and the Elizabeth Glaser Pediatric AIDS Foundation.

11) Agenda Item 12.4: mHealth: View the joint statement from Global Health Council, supported by Living Goods.

12) Agenda Item 12.6: Maternal, infant, and young child nutrition: View the joint statement from Global Health Council, supported by the American Academy of Pediatrics, NCD Child, and ACTION Global Health Advocacy Partnership.

13) Agenda Item 12.8: Rheumatic fever and rheumatic heart disease: View the joint statement from Global Health Council, supported by Partners In Health.


You Can’t Have Universal Health Coverage Without the Community

This guest post was written by Rita Bulusu, Deputy Director of Living Goods’ Community Health Strengthening Team. Living Goods supports networks of ‘Avon-like’ health entrepreneurs who go door to door to teach families how to improve their health and wealth and sell life-changing products such as simple treatments for malaria and diarrhea, safe delivery kits, fortified foods, clean cookstoves, water filters, and solar lights. Living Goods is a 2018 Global Health Council Member.

UHC is the acronym du jour – everyone is talking about how to achieve universal health coverage. But, it’s no surprise that there’s no simple solution. Like any other initiative in history that has successfully created radical change, UHC will require political will, the right people to be allocated sufficient resources, and scaling relatively low-cost, yet effective, interventions.

I urge you to think about what delivering universal health coverage to the poorest, most remote communities in the world really mean. Despite the UHC agenda being dominated by issues of health insurance and financing, it is not a national health insurance schemes that will deliver UHC, but well-resourced and efficient primary health care systems. I would even go one step further and suggest that the face of UHC should be community health workers (CHWs), the individuals physically reaching the last mile to provide basic healthcare to their communities; at a substantially lower cost than facility-based care when it comes to delivering basic services and preventative medicine.

Photo courtesy: Living Goods

The WHO has recognized the importance of CHWs in delivering UHC and is developing guidelines to assist national governments in the design and implementation of CHW programs. It is great to finally see community health being prioritized and governments being given clear guidance to facilitate and develop their own community health efforts. That said it remains a daunting task, especially when considering that national CHW programs require managing the performance and demonstrating the impact of a workforce often several times larger than those on the current payroll, based in disparate locations and with minimal education.

This is where technology can help. mHealth solutions can support governments to improve the quantity and quality of the data collected, improve the consistency and accuracy of diagnosis and treatments, and enable managers to monitor the performance of CHWs and their supervisors on a daily basis. This type of data highlights the direct impact of community health programs and enable more innovative financing methods such as results-based financing.

However, a smartphone in the hands of a CHW – even one that comes with a well-supported mHealth solution – is not a silver bullet. If governments are serious about UHC, they need to design CHW programs that are integrated into the broader healthcare system. This requires them to:

1) Strengthen supply chains, so that CHWs are properly equipped with lifesaving drugs;
2) Have dedicated supervisors able to provide supportive supervision in the field; and
3) Establish effective data collection and reporting mechanisms to provide visibility and accountability at the community level.

At Living Goods, we have shown that a well supervised, well equipped and properly motivated CHW can dramatically reduce child mortality (our randomized control trial showed a 27% reduction in under-5 mortality against our control households), and this can be done for less than $2 per person served a year. After a decade of experience, we are keen to translate what we’ve learned about high impact community healthcare and enable governments to adopt new models to manage their own CHW programs and ensure sustainability.

Happiness, Health & NCDs – Mind the Gap! How can we make public health decisions that make people happy?

This blog post was written by the International Federation of Psoriasis Associations as part of GHC’s Member Spotlight Series. The International Federation of Psoriasis Associations (IFPA) is a non-profit organization uniting national and regional psoriasis associations from around the world. More details on IFPA’s WHA side-event is available on GHC’s Special Events Calendar. IFPA is a 2018 Global Health Council Member.

Psoriasis is a severe chronic, non-communicable, disabling, disfiguring and painful disease for which there is no cure. On a global level, psoriasis affects 125 million people worldwide. The importance of actively working on psoriasis within the wider NCD context and the need for addressing psoriasis holistically derives from the two key facts:

1) Firstly, psoriasis affects the person in a holistic way, beyond the skin, causing severe impact on the body and mind, productivity, access to opportunities in life, participation in the community and more.
2) Secondly, people with psoriasis have increased chances of ‘comorbid conditions’ (such as diabetes, cardiovascular diseases, respiratory diseases, and more) and are affected by the main four risk factors influencing the onset and gravity of NCDs (tobacco use, physical inactivity, unhealthy diet, and the harmful use of alcohol).

Actions on psoriasis open up new possibilities in the way we address the prevention and control of NCDs in general. Psoriasis is at the intersection between the four main risk factors, and the four main NCDs, which allows for action on psoriasis to have a spillover effect in the wider NCD context. Such actions are not necessarily highly resource- demanding as much as they are innovative and based on ‘thinking out of the box’ and better use of current resources.

To answer this potential, and the recent developments in the global NCD agenda, IFPA launched the Global Psoriasis Coalition, a program that unites stakeholders under the joint goal of improving the lives of the 125 million people living with psoriasis through a strengthened NCD advocacy, and innovation, and development of effective health system actions. In 2017, IFPA, with the support of Argentina, Ecuador, Panama, Philippines, and Qatar organized the side event ‘Psoriasis in the NCD Agenda – The Road to 2018’, aiming to educate, present opportunities and call for action in the context of the NCD discussions in 2018.

After this successful event, IFPA and the Global Psoriasis Coalition continued the high-level presence and participation at key NCD-related events and convenings worldwide. More importantly, IFPA continued with the innovative work, which included working with exploring happiness, and what the science behind it can tell us about people living with NCDs, the needs that must be addressed through health systems, and the means of making decisions under the premises of happiness.

On May 24, held on the sidelines of the 71st World Health Assembly, IFPA’s side event ‘Happiness, Health & NCDs – Mind the Gap! How can we make public health decisions that make people happy?’ is a co-sponsored event between IFPA and the NCD Alliance, set to take place as an external event at the International Red Cross and Red Crescent Museum.

The side event aims to:

1) present the latest research on happiness among people living with NCDs
2) showcase the connection between happiness and health and happiness and health
3) systems performance, including universal health coverage
4) showcase initiatives to involve people living with NCDs in policy processes,
5) explore and get inspired by various successful happiness-oriented policies, that have been implemented by Member States; and
6) provide direction on where the Third High-Level Meeting (HLM) on NCDs should aim if public decisions are to create happiness in people, increased quality of life and wellbeing.

More details on the WHA Side-Event is available on GHC’s Special Events Calendar.