Author: Elizabeth Kohlway

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Global Health Council (GHC) Welcomes Legislation Extending PEPFAR

WASHINGTON, DC (August 9, 2018) – This week, Global Health Council welcomed the introduction of the President’s Emergency Plan for AIDS Relief (PEPFAR) Extension Act of 2018 on Friday, August 3 by the U.S. House of Representatives. The legislation, sponsored by Representatives Chris Smith (R-NJ), Barbara Lee (D-CA), Ileana Ros-Lehtinen (R-FL), Karen Bass (D-CA), Ed Royce (R-CA), and Eliot Engel (D-NY), reauthorizes PEPFAR for five years and reaffirms the bipartisan support and commitment to end the HIV/AIDS epidemic.

“We know that investments in global health work, and PEPFAR is a prime example of that,” stated Loyce Pace, President and Executive Director of Global Health Council. “Over the past 15 years, PEPFAR has had an impact on the lives of those living with HIV/AIDS, as well as building health systems to address malaria, TB, and maternal and child health. By renewing our commitment to this groundbreaking initiative, we emphasize its value and pave the way for even more global health progress worldwide.

Since its inception, PEPFAR has supported HIV treatments for more than 13.3 million people around the world, and has put us in reach of an AIDS-free generation with more than 2.2 million babies born HIV-free.

Global Health Council looks forward to working with policymakers and community stakeholders toward the goal of an AIDS-free generation.

***

About Global Health Council

Established in 1972, Global Health Council (GHC) is the leading membership organization supporting and connecting advocates, implementers, and stakeholders around global health priorities worldwide. GHC represents the collaborative voice of the community on key issues; we convene stakeholders around key priorities and actively engage with decision-makers to influence global health policy. Learn more at www.globalhealth.org.

Media Contact

Elizabeth Kohlway
Senior Manager, External Affairs and Operations
Global Health Council
(703) 717-5251

Global Health Security: Take Action to ‘Close the Gaps’

This event summary on GHC’s WHA71 side event, Getting Local with Global Health Security: A Path Toward Sustainable Action, was written by GHC member and WHA delegate Jo Anne Bennett. 

Speakers at this opening-day session characterized the key to health security in terms of addressing health systems’ endemic problems: absent or insufficient frontline health workers, inefficient supply chains, and poor data systems. In other words, the foundation for preventing epidemics is a well-functioning health system ‘on the ground’ in communities.

A point repeatedly made was the need to get past identifying system weaknesses and take action to ‘close the gaps.’ A common theme was prioritization, specifically the challenge of prioritizing in the context of competing priorities and prioritizing according to available means. Rwanda’s health minister framed this challenge as stepwise moving toward Universal Health Coverage: focusing in communities ‘because that’s where problems are and that’s where solutions must be.’ Community action plans start with a large list of priorities that becomes shorter as actions are taken.

Former CDC Director Tom Frieden addresses a packed room for a WHA71 side event on global health security.

Tom Frieden, President and Chief Executive Officer of Resolve to Save Lives and former Director of the Centers for Disease Control and Prevention (CDC), explained how countries participating in the Global Health Security Agenda can use Joint External Evaluations (JEEs) to help clarify priorities related to core capacities. The few JEEs conducted thus far provide a good news/bad news story: The good news is that progress is possible: countries have improved along some criteria that have not been fully achieved. The bad news is that for some criteria no countries have progressed and some countries show no progress on any criteria. Frieden said the disappointing results called for analysis and action.

Keynote speaker Peter Sands, Executive Director of The Global Fund, took up the call for analysis of the underlying weaknesses. Smart investing, he said, rests on the “right analysis,” i.e., analysis that turns knowledge about gaps to costed action plans.  He provided the business case for investing in prevention rather than preparing for response. Using MERS and Zika as examples, he described how the staggering local and worldwide economic impacts of even relatively small epidemics reach far beyond the affected region(s).  Smart investing looks at activities that can achieve dual outcomes, not just emergency preparedness.  He pointed to the Global Fund as an example of recognizing the links across programmatic silos. Similarly, basic public health activities can be leveraged to strengthen core health security capacity.

Chief Executive Officer at Foundation for Innovative New Diagnostics (FIND) Catharina Boehme’s remarks lent further support to prioritizing prevention over response: the reality is that there is no quick scale-up for diagnostics and no diagnostics are available for six of the nine diseases prioritized by WHO.

Dr. Rüdiger Krech, Director of the Department of Ethics and Social Determinants of Health at the World Health Organization (WHO), reflected on the importance of country ownership and political will.  National leadership provides the system-wide view to ensure that all parts of the whole are being addressed. The JEEs simply expose weaknesses.  Everyone needs to understand the implications of just one case.

Universal Health Coverage: ‘More Than Just An Aspiration’

This event summary on GHC’s WHA71 side event, Diverse Pathways and Partnerships to Universal Health Coverage, was written by GHC member and WHA delegate Jo Anne Bennett. 

GHC delegate and NCD patient advocate Kwanele Asante shares her unique perspective on pathways to UHC.

“More than just an aspiration” was the opening and consistent theme of this session. Global Health Council (GHC) President and Executive Director Loyce Pace invited discussion on ‘really finding how to chart pathways to achieving universal health’ and speakers all emphasized the axiom that ‘one size does not fit all’ and success would be achieved, could only be achieved, through multiple approaches –i.e.,” country-driven pathways.” The commonality underscored by all speakers was that efforts needed to be patient-centered/patient-driven, with concrete, system-focused capacity building at the community level. Such effort depends on political commitment, but patient advocate Kwanele Asante Shongwe from South Africa pointedly emphasized that political commitment is not sufficient: “Patients aren’t looking for political commitment,” she said, ”they need real change.” She noted that commitments needed concrete timeframes that address both global and within-country disparities and service quality as well as access. Subsequent speakers echoed her points.  Dr. Mariam Claeson , Director of the Global Financing Facility reminded us that universal health care is not the goal, but rather the means to the goal of health and well-being.

There was little agreement with the view presented by U.S. Secretary for Health & Human Services Alex Azar that a system based on market forces most effectively allows patient choice. Acknowledging that each country should choose its own approach, he maintained that the market approach, accompanied by price transparency, allows patient-choice to reflect assessment of service value. He pointed to effective U.S. global initiatives that helped strengthen system capacity, such as PEPFAR and PMI. Unfortunately, he had to rush to another engagement and did not have the opportunity to hear the panel’s diverse insights.

Uganda’s Minister of Health Dr. Jane Aceng, in her keynote, described user fees as a barrier to accessing available services and thus a hindrance to equitable access. Uganda eliminated user fees in 2001, replaced by diverse insurance schemes: social, commercial and community. Its current 10-year financing strategy (2016-2025) addresses quality as well as access by “steering resources in the right direction” through results-based financing. Health extensions workers are paid and work in village-based teams.

Barbara Stilwell, Senior Director of Health Workforce Solutions at IntraHealth, agreed with panel moderator Harvard University professor Ashish Jha’s statement that the two overarching challenges for an effective model are financing and delivery and pointed out that human resources for health is the second biggest bill for any minister. She described three ways IntraHealth has tried to innovate: Electronic systems allow better resource management by tracking location, age/seniority, and skill-level of workers throughout the sector. Locally-driven public-private partnerships can facilitate funding that incentivizes a worker pipeline to specific areas of need by offering decent working conditions, pay, and retirement benefits. 

Kenneth Mugumya, Director Government Relations and Advocacy at Living Goods also emphasized the importance of data to track financing, human resources, and quality of care.  He described how “mini-doc” in smartphones facilitated the latter by providing technology-driven supportive supervision, continuing education and guidance to standardize daily routines, and a dashboard of managerial data.

Dr. Angela Gichage, the CEO of Financing Alliance for Health, pointed out the dual interest of both the Minister of Health and Minister of Finance in avoiding fragmented financing: integrating services adds value. She spoke to the importance of accessing concession funds for community health. The issue of fragmentation was echoed by other panelists who emphasized the need for system solutions. Stillwell, for example, pointed to barriers that kept frontline workers from using all their skills or working ‘at the top of their license.’

Dr. Claeson underscored that bringing initiatives to scale required realistic timeframes for reaching outcomes and thus “process-for-impact” metrics that allow practical year-by-year tracking of progress.  While Dr. Jha noted an underlying theme regarding digital solutions, Dr. Claeson also pointed out the need to distinguish the simple and complicated processes where digital support is useful from the more complex issues requiring judgment and ‘just-in-time’ decision making.

The consensus among panelists and in attendees’ comments was that Universal Health Coverage will be a journey, more than a destination, and that while there is no unique solution, public financing is needed along the way.

The GPW: Making the Impossible Work of the World Health Organization Possible

This post was written by Elizabeth Montgomery Collins, MD, MPH, DTM, Global Health Council individual member and delegate to the 71st World Health Assembly in Geneva, Switzerland. 

In 2000 the United Nations (UN) marked a new era in global development policy by adopting eight highly ambitious Millennium Development Goals (MDGs) to be achieved by 2015 to address the world’s most basic development needs, ranging from fighting extreme poverty to fighting HIV/AIDS.  Building on the MDGs’ success, the UN subsequently extended its global development agenda by adopting the Sustainable Development Goals (SDGs), which represent an even broader and more audacious attempt to eliminate poverty, hunger, and disease from the world.  The SDGs are so ambitious, in fact, that many of the 17 goals appear to be virtually impossible to attain.

So, how will the world accomplish these very specific levels of achievement by 2030?

As with the MDGs, achieving the SDGs will require a combination of local, regional, and global action.  Member States are expected to continue the initiatives that enabled them to achieve many of the MDGs, and the UN, through its various subsidiary organizations, will no doubt continue to push for advancement on all fronts; but the question remains:  How, specifically, will the World Health Organization (WHO), as the official UN body charged with overseeing international health policy and progress, tackle those objectives relating to health on the SDG list—in particular, SDG 3, which seeks to “ensure healthy lives and promote well-being for all at all ages”?

WHO Director-General, Dr. Tedros Ghebreyesus (Dr. Tedros), proposes to make this seemingly impossible goal a reality by implementing the step-by-step plan set forth in the 13th General Programme of Work (GPW 13) for 2019–2023.  In GPW 13, Dr. Tedros seeks to transform the vague exhortations of SDG 3 into a concrete, measurable plan of action.

And, he fast-tracked the plan for approval.

In January 2018, after input from UN Member States, other UN bodies, WHO staff, non-State actors, and an Expert Reference Group, GPW 13 was presented as a draft to the WHO Executive Board (EB) at WHO headquarters in Geneva, Switzerland.  With some revisions, the EB adopted GPW 13 for consideration as resolution EB142.R2.  Following discussions of the 46-page draft document A71/4 as provisional agenda item 11.1 in May 2018, the Seventy-first World Health Assembly (WHA71) delegates formally approved GPW 13, one full year in advance of its proposed implementation date.

Many countries made strong statements in support of GPW 13 during the plenary session of WHA71, including Singapore, Jamaica, Poland, and the Republic of Korea, with Denmark stating that “we want these ambitions to be translated into implementable policies.”

In accepting GPW 13 as resolution WHA71.1, the Member States also requested that the Director-General use GPW 13 to form budgets, keep Member States informed of progress, provide contextual guidance and support regarding the plan to regional and country offices, and apprise WHA75 attendees in 2022 of any intention to extend the plan an additional two years, to 2025, in order to align with the UN’s larger strategic plan cycle.

GPW 13 is a plan of work not just for the Secretariat of the WHO, but also for each UN Member State, as well as the various other stakeholders that seek to achieve the SDGs’ objectives.  In fact, the document makes it clear that it is intentionally drafted in almost impossibly ambitious terms because, as Dr. Tedros declared, “it must be.”  And because no single entity can accomplish the goals on its own, GPW 13 by design invites assistance from the private sector and other strategic partners.

This roadmap, subtitled “Promote health, keep the world safe, serve the vulnerable” lays out three strategic priorities that will lead us to the overarching goal of healthy lives and well-being for all:  universal health coverage (UHC), health emergencies, and healthier populations.

Achieving Universal Health Coverage

The primary objective for this priority is to have 1 billion more people benefitting from universal health coverage.  This number was calculated to achieve SDG target 3.8 of UHC for all by 2030; to do that, at least 1 billion more people will need to have access to essential health services in each five-year period between 2015 and 2030.  The focus is on infectious diseases, noncommunicable diseases, and basic provision of reproductive, maternal, newborn and child healthcare.  Another central aim of the plan is to ensure that out-of-pocket healthcare expenses do not cause catastrophic financial hardship or increase poverty among families, households, and countries.  In order for coverage to be truly universal, WHO will particularly emphasize healthcare access for women and children, and people who have disabilities or difficulty accessing care due to poverty, stigmatization, location, or other challenges.  It is estimated that the investment necessary to create an educated workforce to achieve UHC will account for 50% of the WHO’s total budget for SDG 3.

Addressing Health Emergencies

The goal is to better protect 1 billion more people from health emergencies.  The WHO has committed to a new vector control strategy, cooperated with the Coalition for Epidemic Preparedness Innovations (CEPI), and begun work with Member States to form a Health Reserve Force prepared to immediately respond to health-related emergencies.  The architects of GPW 13 recognize that the methods ultimately adopted for measuring readiness and improvements in rapid response mechanisms will need to be developed in consultation with its myriad partners, and that people who are living in conflict zones or who have been displaced will be among the most challenging groups to protect.

Promoting Healthier Populations

To ensure that 1 billion more people enjoy better health and well-being, WHO is pursuing its agenda across 5 tracks:  increasing human capital throughout the entire lifespan, preventing and fighting non-communicable diseases (NCDs) including mental health conditions, accelerating elimination of the most impactful infectious diseases, knocking out antimicrobial resistance, and crushing climate change effects on health.  Perhaps the most difficult goal to measure, the assessment of this priority will be a composite estimate derived from adding multiple SDG life-improving targets, and scoring “life improving interventions” vs. “no intervention” scenarios, to see how much progress is made when improvements are attempted.  In particular, the WHO will seek to discourage unhealthy behaviors and marketing (particularly towards children) involving tobacco, harmful alcohol use, unhealthy diets, and inactivity.

Dr. Anders Nordström, Ambassador of Global Health for the Swedish Ministry of Foreign Affairs and former WHO Acting Director-General, pointed out at the Panel Discussion of the 13th General Programme of Work hosted by The Graduate Institute of International & Development Studies, that the factors which differentiate GPW 13 from the dozen that came before it, are that “now we have the SDGs” and “in this GPW…we have a goal, a number:  3 billion— and this pushes us to measure”.  In other words, GPW 13 establishes specific objectives that will make measurement and incremental progress achievable, and serve as stepping stones toward achieving the ultimate goal of SDG 3, one billion people at a time.

The WHO seeks to accomplish all this by making strategic shifts in leadership, driving public health impact in every country, and focusing “public health goods” (i.e. norms, standards, conventions, regulatory recommendations, assessment reports, open databases, etc.) on impact.

The WHO will also make organization shifts, reshaping its operating model to drive, measure, and manage impact at the country, regional, and global levels; transforming partnerships, communications, and financing; strengthening systems, health information systems, and processes; and changing the work culture.  Collectively these will entail incidental improvements such as paying interns a wage for the first time, paving the way for more representation by developing countries, increasing the number of women in leadership roles, and creating a more transparent, collaborative, and seamless WHO, unified and acting as one with the UN.

As Dr. Tedros stated in his speech at the Opening of the Seventy-first World Health Assembly “our new GPW or strategic plan is not about reinventing the wheel. It’s about making a bigger impact than we already make.”

Although the plan’s efficacy will be difficult to implement and measure, the WHO intends to focus on outcomes and impact.  One interesting way they might check progress towards their overall mission is to measure healthy life expectancy around the globe.

Because all components of the plan interact with and build upon each other, I believe the GPW has the potential to create exponential improvements in healthcare outcomes as each goal advances, culminating in healthier people living in a safer world, five to seven years from now.  That in fact may be the primary benefit of striving for the impossible:  even if we fall short of some of our marks, we can likely still make remarkable progress.

I commend Dr. Tedros’ leadership on establishing GPW 13 and encouraging states to “walk the talk” on these objectives.  The WHO must, through inspirational leadership, motivate individuals, families, communities, nations, and regions to address all of these items at the earliest junctures possible, for individuals at the earliest age possible, while aiming for the highest quality of healthcare and health possible.  One of the most important steps in making the SDGs a reality will be the creation of higher education centers to provide the necessary training of healthcare workers worldwide.  Partnering to build, distribute, and appropriately pay a capable health workforce will contribute substantially to the triple-billion goals.  If the WHO can enlist the help of academia for expertise, the private sector for resources, and civil society for input, including from children and adolescents, the world’s citizens may indeed enjoy healthier and happier lives, and reap the physical and emotional benefits of a health-focused world built from the GPW 13 blueprint.

When Dr. Ilona Kickbusch, Director of the Global Health Centre of The Graduate Institute-Geneva and moderator of the Introduction to the WHA: a briefing for delegates held just before the WHA 71 kicked off, asked about society’s current mindset in relation to the WHO’s master plan, Loyce Pace, President and Executive Director of the Global Health Council, answered emphatically that “[t]he shift from healthcare to health is something that the public can understand.  Civil society is ready for an emphasis on health…and the public wants to access more health.”

Adding, “We are ready.”

In his WHA71 Closing Speech, Dr. Tedros laid out the challenge that ultimately stands before us: “Now it’s time to implement it.  We have no time to lose.  Five years is no time.”

Advocacy Update ~ April 23, 2018

This post was written by Danielle Heiberg, Senior Policy & Advocacy Manager, and Melissa Chacko, Policy Associate.

Changes Announced at USAID
In early April, USAID unveiled a proposed reorganization of the agency designed to support Administrator Mark Green’s mission to end the need for foreign assistance. The plan is the latest step in the “redesign,” now known as “transformation” plan, that had been launched in spring 2017 by the Office of Management and Budget. The plan outlines several broad goals that include elevating humanitarian assistance; building resilient communities and countries; and focusing on conflict prevention and stabilization. Several new bureaus would be created to oversee these areas of work including a Bureau for Resilience and Food Security, which would house two “Centers of Excellence” focused on nutrition and water, and a Bureau for Development, Democracy, and Innovation, which would bring together existing work on technical and program design. In addition, a new bureau is proposed for better integration of policy and budget, which would include coordination of new “self-reliance metrics” – indicators measuring the progress of countries toward transitioning from foreign assistance.

No changes were proposed to the Bureau for Global Health, and global health is largely absent from the proposal. In briefings with stakeholders, USAID staff have stated that they will ensure coordination between global health and the new centers for nutrition and water under the new structure.

Comments on the proposed plan can be made to USAID by May 4 (to receive a copy of the plan, please email advocacy@globalhealth.org). A final plan is expected to be presented to Congress this summer.

Appropriations Update

  • FY 2018 – Update on Rescission: As we reported in the last Advocacy Update, President Trump and a few House Republicans are considering a rescission bill, which would cut appropriated funds from the final Fiscal Year (FY) 2018 spending package. In the absence of a line item veto, rescission is a way for President Trump to cut funding to specific accounts. Senate Majority Leader Mitch McConnell (R-KY) has dismissed a rescission, saying that it would be a bad idea to “walk back” from a deal made with Democrats on the Omnibus. The administration, however, seems to continue to push the idea and will send Congress its rescission requests by early May. Both chambers would need to approve the cuts by a simple majority.
  • FY 2019 Update: Chairman Richard Shelby (R-AL), who took over the Senate Appropriations Committee upon Senator Thad Cochran’s (R-MS) retirement on April 1, has stated that he would like to have FY 2019 bills marked up and on the Senate floor by June. President Trump has said that he does not want to sign another omnibus, so it’s expected that Congress could pass several “minibuses” or individual appropriations bills combined into small spending packages.

USAID Administrator Mark Green is on the Hill this week to testify before the House and Senate Appropriations subcommittees on State Foreign Operations and Programs (SFOPs) on the FY 2019 budget request for USAID. Administrator Green will appear before the House subcommittee on April 26 at 2:00 pm. He is expected to appear before the Senate subcommittee on April 24.

Senate Foreign Relations Committee Holds Nomination Hearing for Mike Pompeo
On April 12, the Senate Foreign Relations Committee held a nomination hearing for Mike Pompeo to serves as Secretary of State. While the hearing touched upon State Department funding and human rights, there was no focus on development or global health. On funding, Pompeo said that he would defend needed resources for the State Department. Further when asked by Senator Ben Cardin (D-MD) if Pompeo would spend the funds that Congress appropriated to the agency Pompeo stated that “he had a legal requirement to do so and would try to make sure he’s doing so in a way that delivers value.” With Pompeo’s hearing behind us, we are now waiting for a decision from the Senate Foreign Relations Committee, with a vote possible as early as this week.

Dr. Kenneth Staley named the New U.S. Global Malaria Coordinator
In early April, the White House announced Dr. Kenneth Staley as the new U.S. Global Malaria Coordinator with the  U.S. President’s Malaria Initiative (PMI). Previously Dr. Staley worked on product development and innovation as a Director of Medtronic, and for the last few years, he was with McKinsey and Company, where he led teams working on public health crisis response, including Ebola and Middle Eastern Respiratory Syndrome (MERS). Dr. Staley takes over a newly expanded PMI: in September 2017 USAID Administrator Mark Green announced new country programs in Cameroon, Cote d’Ivoire, Niger, and Sierra Leone and an expanded country program in Burkina Faso.