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The World Commits to the AMR Fight

This blog was written by Danielle Heiberg, Advocacy Manger, Global Health Council and Matt Robinson, MA, Advocacy and Policy Officer, Global Health Technologies Coalition (GHTC)

Photo credit: Matt Robinson, GHTC

For only the fourth time, the United Nations General Assembly (UNGA) convened a high-level meeting focused on health, which was held during the recent 71st UNGA. Following on the footsteps of the recently released “Review on Antimicrobial Resistance” report (commonly referred to as the O’Neill report), member states gathered to discuss antimicrobial resistance (AMR) and global and national commitments to address this threat. The report estimates that by 2050, 10 million people will die every year because of AMR and the rise of “superbugs.”

At the heart of the high-level meeting was an acknowledgement that the threat of AMR is very real, with multidrug-resistant tuberculosis accounting for one-third of AMR deaths every year and some infections, such as gonorrhea, now only treatable using the last class of antibiotics available. Member states want to address today the overuse of antibiotics, both in human and animal health, improvements in infection prevention and control, and supporting R&D that brings new medicines to market, in order to prevent a return to the days when a scraped knee could kill a child.

Before diving into the outcomes of the high-level meeting, it is worth noting a few things that characterized the conversation. First, it is clear that there was a conscious effort on the part of the meeting organizers to use the platform of the General Assembly to reframe AMR as a “One Health” issue where agriculture, animal health, and human health are all aspects to be addressed in an AMR response. And while the World Health Organization (WHO) does not have the authority to direct policy for the Food and Agriculture Organization (FAO) or the World Organization for Animal Health (OIE), the General Assembly does, and it was clear (both from the framing of the summit and the text of the political declaration) that expectations are that the three United Nations (UN) agencies will work together for a coordinated response. Second, the sense of unanimous agreement in the room is something rarely seen at the UN. While there may have been some discussions around the edges of specific technical language, the impression was that member states and UN agencies are on the same page and committed to addressing AMR (unlike HIV/AIDS, for example, where even countries who endorsed the declaration had concerns around some of the action points).

The political declaration on AMR, universally endorsed and formally adopted by member states, specifically calls for:

1. Countries to commit to:

a. Developing appropriate action plans and policies to address AMR.
b. Mobilizing additional resources, including for innovative approaches and R&D.
c. Ensuring that surveillance is part of these plans.
d. Undertaking public awareness and education activities on AMR and the dynamics that drive it (including a focus on patient-driven demand for antibiotics).
e. Utilizing a multisectoral model incorporating innovative partnerships and incentive mechanisms to pursue the “One Health” approach.

2. WHO, FAO, and OIE should finalize a global development and stewardship framework to both protect the effectiveness of current technologies as well as to support the development of new technologies.

3. WHO, FAO, OIE, the UN, multilateral development banks, and all other stakeholders should support the national, regional, and global action plans described above.

4. The Secretary-General should establish a cross-UN coordinating group cochaired by WHO and the Secretary-General’s office to guide efforts on AMR, as well as to prepare a report for the 73rd General Assembly outlining progress and recommendations to accelerate it.

In the context of the recent release of the report of the High-Level Panel on Access to Medicines (HLP), it is also worth noting that concerns around access to medicines are also evident in the AMR declaration. Unlike the broader access to medicines debate, however, there is a clear acknowledgment of the need to discourage overuse of antibiotics to preserve their effectiveness while ensuring that those who need them have access.

Overall, the future implications of the high-level meeting and declaration will depend on what happens next. AMR is squarely on the international agenda and the meeting brought the global community together in an expression of shared desire to fix the problem, which is entirely positive. Unfortunately, shared desire is by no means sufficient to address a problem as complex as AMR. As one panelist said, “If I have three key points, they are implementation, implementation, implementation!” The determinant of the meeting’s success lies in whether the action plans are developed and then acted upon. As for the role of civil society and nongovernmental organizations, holding governments accountable over this is precisely where the global health community can step up through advocacy and mobilizing public pressure to create political will.

WHO, European Regional Conference 2016

This guest blog was provided by GHC member, Pamela Namenyi, FNP, PNP

Yesterday wrapped up the 66th European WHO Regional Conference with 53 member states represented by high level representatives and health ministers from across Europe. Dr. Margaret Chan joined the meetings Wednesday and Thursday as discussions continued. Presentations and discussions began Monday, September 12 and ended Thursday, September 15. All meetings were held at the WHO regional office in Copenhagen, Denmark.

The week was full of colorful discussions and although tensions increased during discussions of policy on sexual and reproductive health, many urgent action plans were unanimously approved.

A highlight of the week was the presence of Mary, Crown Princess of Denmark who accompanied WHO members and delegates to evening events Monday at the Louisiana Museum of Modern Art and Tuesday arriving by boat from the royal palace for entertainment at the Royal Opera House.

Regional Director, Zsuzsanna Jakab with Her Royal Highness, Mary, Crown Princess of Denmark

Regional Director, Zsuzsanna Jakab with Her Royal Highness, Mary, Crown Princess of Denmark

Day 1 highlights included continuation of the reform of WHO’s work in health emergency management based on the Ebola outbreak approved for budget during the WHA, May 2016 meetings. The central theme to the conference resounded throughout the week as ‘leaving no one behind’ in terms of health and wellbeing. The Crown Princess of Denmark emphasized in an opening speech that girls and women are key to building healthy, prosperous and sustainable societies and communities.

Day 2 meetings involved the Regional Committee adopting European strategy and action plan for refugee and migrant health following a human rights approach with special attention given to more vulnerable populations including migrant women and children. Presently, the migrant population in the European Region is estimated at 8% or 77 million people.

Day 3 brought agreement on Women’s health strategy as well as action plans for HIV and Viral Hepatitis. Dr. Margaret Chan gave her final address to the WHO Regional Committee for Europe as the WHO Director General. Dr. Chan congratulated the Region for being at the forefront of global environmental policy, non-communicable disease prevention, whole of government and society approaches, people centered health systems, mother and child health and the rights of women and girls.

Day 4 concluded with member states approving European action plan for prevention and control of non-communicable diseases. Also adopted was a European action plan to strengthen the use of evidence from information and research for policy making.

Dr. Margaret Chan, WHO Director General and Regional Director, Zsuzsanna Jakab

Dr. Margaret Chan, WHO Director General and Regional Director, Zsuzsanna Jakab

The WHO, European Region has developed an online ongoing European Health Information Gateway project that integrates regional office data in order to achieve a single health information system for Europe. Information, data and evidence from 53 Member States of the European Region, international organizations and academic institutions are pulled together for public and organizational understanding. The information is available in English and Russian. Check it out for up to date European health information

Pamela E. Namenyi has her BS in Human Nutrition and Nursing. She went on to study her dual Masters at Wright State University in Family and Pediatric Health. She has lived abroad in several countries including Australia, India and Iran where her interests in global health began. She has a passion for global health and those populations with decreased access to healthcare and high health risks due to life circumstance. She is presently continuing her Masters studies in Global Health Policy at the University of London.


Congress Returns After Summer Recess

Congress returned to Capitol Hill this week to deal with Fiscal Year 2017 (FY17) appropriations and funding the domestic response to Zika. With fewer than 20 days remaining in the Congressional schedule before the election and FY16 ending on September 30, little time remains for Congress to address these issues. Earlier this week, Senate Democrats rejected by a procedural vote to advance legislation that would have provided additional funding for the domestic Zika response. The$1.1 billion bill was rejected due to GOP riders, including one to defund Planned Parenthood, attached to the legislation. Congress could potentially attach Zika response funding to the FY17 legislative package. In regards to FY17, Congress is expected to pass a Continuing Resolution (CR) to keep the federal government open beyond September 30. However, it still remains unclear if the CR will expire in December, in which case Congress will return for a lame duck session to complete the federal budget, or if a longer CR will last until March and the new Congress will finish up the FY17 budget.

A Strategy to Deliver a Fit-For-Purpose Global Health Workforce

By Vince Blaser, Director, Frontline Health Workers Coalition

The placards went from horizontal to vertical—indicating their nation wished to speak. One after another—from Guinea to Switzerland, Thailand to the United States—they spoke with impassioned tones about the centrality of strategically addressing the health workforce gaps exasperatingly standing in the way of the enormous progress we know can be achieved in global health in the next 15 years.

And then, after civil society chimed in with similar calls of praise and pleas for vigilance – the chair called for objections. There were none, and the first ever Global Strategy on Human Resources for Health: Workforce 2030 went from draft to reality.

Working in global health advocacy, you rarely see such a vivid display of the collective work that leaders of the Frontline Health Workers Coalition (FHWC) witnessed in Geneva this past May when the world’s health ministers unanimously approved Workforce 2030 at the World Health Assembly.

Flashback two-and-a-half years across the Atlantic Ocean in Recife, Brazil. Fifty-seven member states had just made five-year commitments of variable muster in addressing their country’s health workforce challenges—nearly all of the commitments coming from low- and middle-income countries. Over a dinner with health workforce policy leaders from around the world that FHWC, USAID, and others help organize, a conversation began about the acute need for a global consensus on a strategic direction to address the most severe human resource-related barriers to ensuring everyone worldwide has access to essential health services.

The Global Health Workforce Alliance carried forward a two-year, multipronged consultation process with stakeholders from all sectors in all regions that delivered a framework for the World Health Organization to work with member states to draft Workforce 2030, which was strongly championed by USAID and across the U.S. government.

So what does the strategy say? In brief, it sets out a vision of “accelerating progress towards universal health coverage and the UN Sustainable Development Goals by ensuring equitable access to health workers within strengthened health systems” and a series of milestones by 2020 and 2030 to achieve this vision.

And why is this important for global health progress? Consider this:

We are encouraged that the strategy provides a common framework for all countries and stakeholders to ensure a robust and resilient global health workforce; however, a strategy is just a piece of paper if not backed by a fervent effort to ensure the right investments and policies are in place.

On that front, we are hopeful that the report due this month by the United Nations High-Level Commission on Health Employment and Economic Growth, and commissioned by UN Secretary-General Ban Ki-moon in March, will have bold recommendations on how countries, donors, and civil society can work together for a fit-for-purpose health workforce we need to achieve the SDGs.

We at the Frontline Health Workers Coalition celebrate the passage of  Workforce 2030, but the global health community must be vigilant to ensure its promise becomes reality.

Member states debate adoption of the Workforce 2030 strategy at the World Health Assembly in May 2016. Courtesy Vince Blaser, Frontline Health Workers Coalition.


Committed to serving the most vulnerable in South Sudan

This blog was written by GHC member IMA World Health (IMA). IMA’s work in South Sudan is funded by Global Fund/Population Services International, Global Fund/UNDP, Office of U.S. Foreign Disaster Assistance, UK’s Department for International Development/Mott MacDonald, UNFPA, and World Bank/South Sudan Ministry of Health.

In the midst of ongoing violence in South Sudan, an estimated 2.3 million people have been forced from their homes. Most are not involved in the conflict in any way: beautiful souls, living in fear, struggling to survive.

One of their most basic needs as they wait for more peaceful times is access to primary health care.

While more than 700,000 have fled the country due to the war, another 1.6 million are internally displaced, struggling to carry on in makeshift settings. IMA World Health and our partners have continued to provide basic health services to thousands of displaced people in the Upper Nile and Jonglei states. Curative and preventive primary health care, nutrition services for children, reproductive health services, delivery of essential medicines, management of neglected tropical diseases, malaria prevention, and training of health workers continue despite conflict that has displaced staff, destroyed facilities and all but severed logistical lifelines.

IMA works alongside South Sudan’s Ministry of Health, civil society, donors and other critical partners to staff health centers, maintain operations and work to provide health and healing, regardless of who is fighting whom. While working to ensure quality health services are available in the immediate-term wherever people are, IMA’s longer-term goal is to strengthen the capacity of health systems through the states.

IMA's model is to employ local health care staff who are already there—internally displaced people, which gives people a chance to serve their home communities. (MAF/LuAnne Cadd)

IMA’s model is to employ local health care staff who are already there—internally displaced people, which gives people a chance to serve their home communities. (MAF/LuAnne Cadd)

But there are many challenges.

A lack of security in the country continues to be the greatest hurdle. Tensions remain high in some areas, limiting access. “Without a secure environment, you are challenged to do the supervision that you are supposed to do and some activities can’t be done,” Dr. Mounir Christo Lado Lugga, IMA’s Country Director in South Sudan, said. Activities such as door-to-door campaigns, for instance, aren’t an option.

Even apart from the current unrest, the annual rainy season makes basic functions difficult. “When it rains, the terrain is so bad that movement becomes a challenge,” Lado said. Large swaths of Jonglei turn into swamps. Almost all airstrips are dirt—until they become mud. As a way to work around impassable roads, IMA has taken to the Nile to transport medicines and supplies into Jonglei and Upper Nile states. But that’s also not an option now, as barges have become a target for the warring sides.

“River transport is not operational,” Lado said.

County Health Departments had vehicles, such as motorcycles and boats, that staff members and health workers needed for their work, but most of these were looted. And the solar refrigerators that were used to keep temperature-sensitive vaccines and medicine cold during transport have been either damaged or stolen.

As if immobility and insecurity aren’t daunting enough, there is also the issue of the country’s economic crisis. There is a daily floating rate of the South Sudan Pound, Lado explained, which makes procurement difficult. By the time a vendor is selected, the prices have changed. “You do your calculation on a daily basis,” he said. The annual inflation rate in South Sudan surged to 661.3 percent in July 2016.

But hope is persistent and commitment undaunted.

Before the crisis that began in mid-December 2013, Upper Nile and Jonglei states were showing improvement in health service delivery. Lado said all the health indicators were good and, despite all of last year’s challenges, IMA and our partners, such as Sudan Medical Care, were still able to meet 70 percent of the targets for health indicators. This statistic not only shows that health services continue but also that the team in South Sudan is still able to maintain essential communications despite the fog of conflict.

A staggering 20 percent of South Sudan’s population is displaced in some form, according to the 2016 Global Peace Index released in June. The men, women and children who are caught in the middle of this ongoing conflict deserve to lead healthy and productive lives. Despite great adversity, IMA and our partners continue to support the people of South Sudan.

“You cannot imagine the resilience that is necessary,” Lado said. “It’s not easy, but we work together to make sure health services continue. Because they are desperately needed.”