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Global Health Security: Why Women Matter
Maternal child health

As the world responds to a new outbreak of Ebola in the Democratic Republic of Congo, many may not realize that women tend to be at greatest risk. If this outbreak follows previous patterns, as many as 75% of those infected will be women, which has massive implications for families and society at large.
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To help women survive and thrive, it is imperative that health security efforts focus not only on building response capacity to emergencies like the last Ebola pandemic, but on creating more resilient health systems. As I prepare for the World Health Assembly which begins May 22 in Geneva, Switzerland, I hope to help bring more attention to key components of effective healthcare delivery: the availability of quality assured medicines, and the human workforce to sustain services in the face of pandemic threats.
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If these efforts are to have a lasting impact, it is critical that women, already the traditional caregivers in many communities, be part of those efforts.

Women’s Disproportionate Burden

Women are disproportionately affected during health crisis situations for several reasons. Lower socioeconomic standing means women often have poorer nutrition and lack access to education and basic health services. Traditional gender roles means women are more likely to be exposed to disease because they are the primary caregivers. Women prepare meals, care for the sick and attend to the dead. Women also make most health care decisions in the family.  Simply put, women are at the center of global health security.
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High-profile emergencies, such as Ebola, Zika and Influenza, demand responses that require not only effective services, but also effective treatments. But in low- and middle-income countries regulatory authorities often face daily challenges assuring medicines quality, even outside a crisis situation. The growth of online distributors, according to the WHO, now means there is not a single country that is untouched by this problem of substandard or falsified medicines.
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Shortages in quality-assured medicines hamper health emergency responses during outbreaks, they undermine continued efforts to reduce the impact of the tuberculosis, malaria and HIV/AIDS epidemics and impede improvements in maternal and child health outcomes.

Women Leaders in Science, Policy and Practice

Resilience during public health crises requires investing in health systems and people, especially women, as agents of change.
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USP collaborates with the WHO, national medicines regulatory authorities, manufacturers and other partners to increase the supply of quality-assured essential medicines by building technical capacity and human resources at all levels. In Africa, for example, in 2015 USP created the Women in Science Exchange (W.I.S.E.), a program to empower and mentor female students and professionals in science and help them to advance into leadership positions. Recognizing that women are under-represented in the African health workforce, the program paired female students with mentors, African women who are established leaders in pharmaceutical, medical or regulatory science.
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In a recent visit to Myanmar, I was struck by the efforts of the head of the recently accredited National Medicines Quality Control lab, Dr. Khin Chit, to mentor her staff, over 90% of whom were young women, reflecting a similar shift in opportunities in Southeast Asia.

Women leaders in science

USP also provides on-site training for quality-assurance professionals around the world. In 2016, USP facilitated the training of over 1,000 individuals from 19 countries – over 500 of which were women. Together these efforts seek to improve the pipeline of future women scientists. We can all do better to support women in science as part of building resilient health systems.

Looking to the Future

Neither pathogens nor medical products respect national borders. Substandard and falsified medicines may be uncommon in the U.S. and other industrialized and middle income nations but global supply chains and travel make all of us vulnerable to health threats associated with poor quality medicines. They fail to treat infectious diseases and contribute to drug resistance, elevating the risk of further spread, locally and globally.
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To achieve the Sustainable Development Goals, everyone needs medicines that are accessible, affordable and  quality assured. USP is committed to investing in women and strengthening systems across the globe so the medicines people take are quality-assured, no matter their gender or where they live.

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IMA cheers recognition of non-state actors at World Health Assembly

This post was provided by GHC member, IMA World Health, and written by Theresa Nyamupachitu, Health Systems Strengthening Advisor.

They were the busiest six days in Geneva and probably in the world as 194 countries converged for The 69th World Health Assembly. This was a moment set for world health leaders to pause and reflect on the progress made to meet the health needs of their countries and to set their health agenda. The world embraced the Sustainable Development Goals, also known as the 2030 Agenda for Sustainable Development, the new goals, targets and indicators being used to frame global health agencies and policies.

This was an opportunity that IMA World Health would not miss, and so my colleague Nkatha Njeru from the IMA office in Kenya and I were fortunate enough to be part of these proceedings. Putting on two hats as a Global Health Council Delegate and a World Council of Churches Delegate, my two main goals were to gain insights into the current global health issues to better align IMA’s contributions to the health and well-being of all, and to foster the engagement of faith-based organizations at this platform to increase FBO visibility and recognition in global health. IMA is a faith-based international public health organization that works in close partnership with local FBO networks in most African countries known as Christian Health Associations and their regional body, the African Christian Health Associations Platform.

Through several briefings from country delegations made up of high-level government officials, the world celebrated notable successes driven by the Millennium Development Goals, such as 19,000 fewer children dying every day; a 44 percent drop in maternal mortality; 85 percent of tuberculosis cases treated; and a 60 percent decline in malaria mortality. Leaders also noted that antiretroviral therapy, a life-saving treatment, has had the fastest scale-up in history, with more than 15 million people living with HIV now receiving it.

However, many countries reported gaps still remain and challenges lay ahead of meeting the goals and achieving universal health coverage. These include weak health systems; disease outbreaks, such as Zika and Ebola; and emerging health issues such as anti-microbial resistance, non-communicable diseases and mental illness.

Through numerous deliberations, a number of new resolutions were set to guide the new agenda. Among these, the most challenging during negotiations and yet the most exciting is FENSA—The WHO Framework for Engagement with Non-State Actors. After more than four years of intergovernmental negotiations, the WHA adopted a set of guidelines that will strengthen WHO engagement with non-governmental organizations (including FBOs), private sector entities, philanthropic foundations and academic institutions.

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Theresa Nyamupachitu, Health Systems Strengthening Advisor for IMA World Health, makes a presentation on “Training and Formation: Lessons learnt and opportunities for ACHAP and CHAs” during a WCC-ACHAP event titled “Global Public Health: The future of faith-based organizations” on May 25, 2016, during the 69th World Health Assembly in Geneva, Switzerland. (Photo courtesy of Peter Kenny/WCC)

To coincide with this, IMA, ACHAP and several CHA leaders, including Ms. Karen Sichinga of the Christian Health Association of Zambia; Dr. Samuel Mwenda of the Christian Health Association of Kenya and a member of the IMA board; and Dr. Mwai Makoka of the Christian Health Association of Malawi, engaged in discussions and strategic thinking with partners including WCC, WHO and Global Fund on their future role in the 2030 health agenda. FBOs play a significant role in health, serving the most vulnerable populations in hard to reach areas where, in most cases, governments and the private sector have no reach. Yet FBOs remain under-recognized for their immense contributions to the health sector. In many contexts, FBOs are often not integrated into planning and resource allocations for national health systems, leading to service and system redundancies and gaps.

IMA applauds FENSA and views it as an opportunity for the voice of FBOs to be heard and for their role to be recognized at a global level. However, to achieve this FBOs face some critical questions—how prepared are they to extend their reach to those that have not yet been reached; to enhance evidence-based dialogue with governments and stakeholders and demand for inclusiveness; to strengthen capacities within networks to have more impact; and to have stronger religious messages on critical health issues such as immunization and HIV/AIDS.

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WHA69: A New Delegate’s Perspective

This guest blog was written by Dr. Indira Paharia, Individual GHC Member

As a first time delegate at the World Health Assembly (WHA) in Geneva last week, I had an incredible opportunity to peer inside the inner workings of global health policy and even participate in the action.  When I first stepped into the Palais des Nations, I was struck by how large the structure was, consisting of Buildings A through E.  At the opening plenary, obtaining a seat in the upper observatory was an accomplishment, and seeing WHO Director-General Dr. Margaret Chan open the 69th WHA was a privilege.  The Assembly Hall was packed and the passion and excitement for the days ahead was evident.  The hall was filled with Ministers of Health, WHO and UN senior leadership, member state delegates, US officials, and NGO executives – all coming together around a common purpose of improving the lives and health of the world’s citizens.

As the days wore on, several topics were discussed in Committees A and B, and many of these meetings went on into the late evening. By the last day, I was quite familiar with how to use the lifesaving WHA app on my iPhone, as many of us were trying to track which items were moved from Committee A to B and vice-versa, in order to be present to speak on the Committee floor.  And I had the great privilege of presenting to Committee A on a Framework Convention on Global Health (FCGH) on behalf of the GHC. In between sessions and numerous side-events, I wondered the halls of the UN, stopping to admire the beautiful art work, gifts bestowed from many member states, and several WHO exhibits focused on some of the most important health issues of our time.  And of course, I also spent time in the Serpent bar vying for a power outlet and a chair like so many others!  I stayed until the very end when DG Chan closed the WHA at 7 PM on Saturday, May 28.

As a clinical psychologist and a national advisor to the Substance Abuse and Mental Health Services Administration (SAMHSA), I was initially struck and disappointed by the lack of inclusion I saw for mental health and substance use disorders. However, as I engaged in many of the topics, such as communicable diseases, violence prevention, Universal Health Coverage, and emergency preparedness, I began to appreciate how such life and death issues must take precedence.  Nevertheless, within non-communicable diseases, an integrated health systems framework, and women’s and children’s health, I do believe strongly that there needs to be more explicit inclusion of behavioral health. In moving from the Millennium Development Goals (MDGs) to the Sustainable Development Goals (SDGs), WHO has broadened the focus of healthcare’s impact to include the social determinants of health, an important step in achieving global health equity.  Behavioral health plays a key role in this given that mental disorders are the leading cause of years lived with disability globally. We must harness the power of behavioral health in achieving SDG Goal 3.  Put simply, behavioral health is essential to overall health.

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WHO Board addresses health R&D, sets March meeting to discuss CEWG resolution

This blog was written by Marissa Chmiola, and cross-posted from Global Health Technologies Coalition

WHO EB meets. Photo: GHTC/Jana Armstrong

WHO EB meets. Photo: GHTC/Jana Armstrong

Over 1,000 attendees, a longer than ever agenda—with time management by a song for punishment and a chocolate Caramello Koala as a reward—the 138th World Health Organization (WHO) Executive Board (EB), chaired with humor and efficiency by Precious Matsoso, Director-General of the Department of Health, South Africa, concluded Saturday, January 30 after six days of discussion and debate.

The main headlines were WHO emergency reform, WHO reform in general, the Zika response, transitioning from the Millennium Development Goals to the Sustainable Development Goals, universal healthcare, preparation for the United Nations (UN) High-Level Meeting on noncommunicable diseases, the upcoming UN General Assembly Special Session on the World Drug Problem, Framework for Engagement with Non-state Actors, Global Action Plan on Strategies for antimicrobial resistance (AMR), pandemic influenza preparedness, and promoting the health of migrants. The full agenda, associated documents and nongovernmental organization (NGO) statements can be found here.

R&D featured prominently on the agenda

The need for global health research and development (R&D) and access to global health technologies featured prominently in many of the agenda items addressed under Health Systems and Preparedness, Surveillance and Response including:

• 8.2: Pandemic influenza preparedness: sharing of influenza viruses and access to vaccines and other benefits
• 10.2: Comprehensive evaluation of the global strategy and plan of action on public health, innovation, and intellectual property: progress update
• 10.3: Follow-up to the report of the Consultative Expert Working Group on Research and Development: Financing and Coordination (CEWG), Planning for an open-ended meeting of Members States to discuss progress
• 10.4: Substandard/spurious/falsely-labeled/falsified/counterfeit medical products
• 10.5: Addressing the global shortages of medicines and the safety and accessibilities of children’s medication

R&D was also embedded as an important point within some of the key headline items including:

• 6.4: Public health dimension of the world drug problem including the context of the Special Session of the UN General Assembly on the World Drug Problem to be held in 2016
• 7.2: Health in the 2030 Agenda for Sustainable Development
• 8.1: Implementation of the International Health Regulations discussed with 9.1 2014 Ebola virus disease outbreak: follow-up to the Special session of the EB on the Ebola Emergency: section on information sharing on diagnostic, preventive and therapeutic products
• 8.5: Global Plan on antimicrobial resistance
• 9.2: Global health sector strategies: HIV, viral hepatitis, and sexually transmitted infections
• 9.3: Global vaccine action plan
• 9.4: Mycetoma

The EB accepted all of these topics for inclusion in the 69th World Health Assembly (WHA) agenda.

A number of NGOs, including GHTC, weighed in on R&D and access related topics discussed at the EB meeting. Full NGO statements delivered at the meeting are available here.

Three resolutions related to health R&D introduced for WHA

Most of the EB agenda consisted of “recognizing reports,” “providing guidance,” and “reviewing draft strategies,” however, the EB decided to put forward three resolutions for consideration at the WHA in May that have clauses related to R&D:

1. Draft resolution on Health in the 2030 Agenda for Sustainable Development
2. Draft resolution addressing the burden of mycetoma
3. Draft resolution promoting the safety and accessibility of children’s medicines

Small steps taken on CEWG

Agenda item 10.3, follow-up of the report of the CEWG, was particularly important for GHTC and other health R&D advocates. The EB discussed progress on the process and set the agenda for an open-ended meeting on the topic that will take place in March. This meeting is expected to result in a WHA resolution on possible WHO mechanisms for global health R&D priority setting, coordination, and a pooled fund for R&D.

During the discussion, member states and observers made the following interventions:

• All member states supported the Global Observatory on Health Research and Development, a WHO platform created by the CEWG process to collate information on health R&D activities globally to identify gaps and opportunities and define priority areas for new R&D investments.
• Many statements expressed disappointment that funds received to support R&D (US$10 million) are dramatically lower than funding pledges ($85 million).
• Statements were made calling for the new pooled fund to incorporate support for R&D on antimicrobial resistance and emerging infectious diseases, though there was not consensus on this point.
• Several participants questioned how the CEWG process is coordinating with the UN Secretary-General’s (UNSG) High-Level Panel on Access to Medicines.
• The assembly seemed unified on non-state actors being allowed to attend the open-ended meeting, while holding open the possibility of a closed session on financing and coordination of next steps.
• Many participants argued for the need to de-link R&D costs from product price to increase affordable access.
• It was acknowledged that the fund should de-risk investment for low- and middle-income countries.
• Participants recognized a need to interface between work streams—observatory, priority setting and coordination, and the pooled fund.
• Feedback was given on the demonstration projects chosen and not chosen.
• P. Sharma of India was nominated by consensus as the chair of the open-ended meeting.

The following NGOs made statements on this agenda point:

• GHTC (delivered through Global Health Council)
• Drugs for Neglected Diseases initiative
• Médecins Sans Frontières International
• Medicines for Malaria Venture
• Medicus Mundi International Organization for Cooperation in Health Care

GHTC’s statement requested that global health R&D NGOs be permitted to participate in the March open-ended meeting since product development partnerships and public-private partnerships are responsible for 58 percent of the product candidates currently in the pipeline. The decision was ultimately made to include civil society.

In wrapping up this agenda item discussion, Marie-Paule Kieny, WHO Assistant Director-General of Health Systems and Innovation, thanked Member States for their constructive requests and described this process as a marathon, not a sprint. She also highlighted the financial gap facing the current demonstration projects. Regarding the agenda of the open-ended meeting, she said that comments would be taken into consideration and proposed the following revised agenda:

• Day 1:  Progress on strategic work plan and report from the UNSG High-Level Panel on Access to Medicines.
• Day 2:  Presentations of work relevant to the CEWG: neglected tropical diseases; the global action plan for AMR; R&D Blueprint for action to prevent health epidemics; World Intellectual Property Organization (WIPO) research; and trilateral cooperation between WHO, the World Trade Organization, and WIPO on health, innovation, and access. Member state and Non-State actor statements.
• Day 3:  Financing and Coordination.

Looking forward, the 69th WHA agenda will very closely resemble the agenda of this 138th EB since the main point of the January EB meeting is to set the agenda for the WHA. Therefore, it will include important R&D topics including outcomes from the March open-ended meeting, the resolution votes, and the strategic plans discussed at this EB.

Jana Armstrong is a consultant for GHTC based in Geneva, Switzerland.

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SIXTY-EIGHTH WORLD HEALTH ASSEMBLY PLENARY SESSION: BUILDING RESILIANT HEALTH SYSTEMS

This guest post was written by Gillian Franklin, MD, MPH, PhD, Yerby Postdoctoral Fellow, Harvard T.H. Chan School of Public Health.

Plenary session on Tuesday, 19 May 2015, day two of the 68th WHA as the honorable delegates address the Assembly.

Plenary session on Tuesday, 19 May 2015, day two of the 68th WHA as the honorable delegates address the Assembly.

May 18, 2015: The excitement filled my heart as I walked into the Palais des Nations wide-eyed and ready for the opening of the first day of the Sixty-eighth World Health Assembly (68th WHA). Of particular interest to me were the WHO Director-General Dr. Margaret Chan’s opening speech, and the invited speaker Angela Merkel, Chancellor of the Federal Republic of Germany address to the Assembly.

Chancellor Merkel addressed the Assembly, calling for a new plan to cope with issues such as the Ebola outbreak. She emphasized the urgent need for collaboration and a new action plan to respond swiftly in emergencies like the Ebola outbreak. She also stressed the importance of having well-designed, efficient infrastructures in place in such global emergencies.

Dr. Chan’s focus later in the day was on WHO reform as a result of lessons learned from the recent Ebola outbreak. She discussed developing and overseeing of a new program that will be faster and more flexible in addressing health emergency operations. In her words, “the world was ill-prepared to respond to an outbreak that was so widespread.”

The Honorable Delegate from Malaysia Datuk Seri Dr. S. Subramaniam, Minister of Health (right); Dr. Gillian Franklin (left) – May 19, 2015.

On the second day of the 68th WHA, I attended the plenary hearing where honorable delegates from various countries specified their quest for building resilient health systems in their respective countries, outlined goals, and emphasized their progress towards improving their country’s public health infrastructure in light of the Ebola outbreak. Some of the countries along with quotes from their honorable delegates included: Portugal (“…focus on health promotion and disease prevention…”), Chile (“…adapt and respond to disasters, such as tsunamis, landslides, forest fires, earthquakes…”), Poland (“…affordable drugs and vaccines…”), Malaysia (“…life course perspective…”), Islamic Republic of Iran (“…capacity building and the importance of a paradigm shift…”), Kenya (“…comprehensive plan to guide Ebola response…”), Spain (“…comprehensive health care and building health information systems…”), Slovakia (“…integrated health system model…”), and Haiti (“…coordinated responses and action plans…”).

It was an honor to meet the honorable delegate from Malaysia Datuk Seri Dr. S. Subramaniam, Minister of Health after he spoke about the consequences of the Ebola outbreak, and the lessons his country learned from observing this crisis in countries with poor health systems. Dr. Subramaniam further discussed the need for, and outlined the following seven components that he felt were of importance for building a resilient health system:

  1. Must have evidence based public health policies in place
  2. Must have proper linkages in the system
  3. Must have proper infrastructure and foundations to be able to respond
  4. Must have strong and interactive communications
  5. Must be adaptive and quick to respond
  6. Must have the ability to predict and respond to crisis
  7. Must have regular drills to test out these systems

The 68th WHA was fertile ground for addressing the reforms needed, especially after the Ebola outbreak. A common theme from several countries included lessons learned form the recent Ebola health crises in countries with no or poorly built public health infrastructure. Countries set goals for improving their current public health infrastructure, and outlined priorities for building more resilient health systems for efficient disaster response in the future.

I look forward to the rest of the week’s 68th WHA events.

Full transcripts and videos of the Sixty-eighth World Health Assembly Speeches are available and can be viewed.

Harvard T.H. Chan School of Public Health: To advance the public’s health through learning, discovery, and communication.

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