Rethink your role in Global Health

How you fund things, and how adequately you fund them, is a major determinant of success, says Amanda Glassman, director of global health policy and a senior fellow at the Center for Global Development, a Washington-based think tank. Rolf Rosenkranz, editor at Devex, spoke with Glassman about financing global health.

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Insider look: GiveWell

The latest edition of Impact magazine seeks to uncover global health’s best investments, identify global health trends, and discuss barriers and solutions to scaling up promising interventions. Read the interview below from the issue,  find the rest of the articles from the magazine here, and continue the conversation on Twitter using#BestBuys4GH.

Impact: GiveWell is known for using the very clear and direct framework of ‘proven/cost-effective/scalable’ when evaluating charities for public health. With your initiative, GiveWell Labs, you’re moving into new territory with the evaluation of areas outside public health and less straightforward frameworks. What was the impetus for this change and what challenges are you experiencing?

GiveWell: When GiveWell started, its co-founders had no experience in the non-profit sector, so they decided to focus on programs whose impact is easiest to measure: interventions with strong formal evidence of effectiveness from high-quality studies, such as randomized controlled trials. Now that we’ve been using this approach for a long time, we’re eager to learn about opportunities that might have great impact even if they are harder to measure, which is what GiveWell Labs is designed to do.

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The Daily Impact: Uganda experincing economic and diplomatic fall out following anti-gay bill

March 31, 2014 Uganda, who’s tough new anti-gay law prompted stiff criticism and aid cuts by Western donors, is now facing a heavy diplomatic and economic fallout despite its role as a key regional ally. From the AFP:

Annual foreign aid to Uganda accounts for a fifth of Uganda’s 12 billion dollar (8.6 billion euro) annual budget, but while several European nations have cut some aid, they appear unwilling to totally undermine veteran President Yoweri Museveni.

“It is not going to push Uganda into a huge recession, but it could shave off one or two percent off GDP growth,” said Harry Verhoeven, who teaches African politics at Britain’s University of Oxford.

“The resolve of the EU countries to hold up aid is stronger than President Museveni thinks,” Verhoeven said. “I would not underestimate what the long term damage could be.” Museveni last month signed off on one of the world’s most severe anti-gay laws, which states that “repeat homosexuals” should be jailed for life, outlaws the promotion of homosexuality and requires people to denounce gays to the police. Diplomats and rights groups had been hoping the president, who is already under fire from key Western donors over alleged rampant graft and for stifling opposition groups and media, would refuse to sign the legislation into law. US Secretary of State John Kerry likened the new law to anti-Semitic legislation in Nazi Germany and warned it could damage ties with Washington. The World Bank froze a loan of $90 million (65 million euros), while Denmark, the Netherlands and Norway have halted or changed aid programmes. The aid cuts will impact the poorest, many warn.

Francois Audet, from Canada’s Research Institute on Humanitarian Crisis and Aid, warned that the “resources the country receives are indispensable to its survival.”

“If aid is cut it would be very hard on services,” said Bildard Baguma, deputy chief of Uganda’s Red Cross.

“Even if it is just cut to government aid, it will certainly have an impact since so many programmes are funded with donor money. It would end up affecting mostly the poor.”

Museveni’s support for the law was seen as a move to bolster popular domestic support ahead of presidential elections scheduled for 2016, which will be his 30th year in power.

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Seven questions with Peter Singer

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Peter Singer is the Ira W. DeCamp professor of Bioethics in the University Center for Human Values at Princeton University. He is also laureate professor at the University of Melbourne, first in the Centre for Applied Philosophy and Public Ethics, and then in the School of Historical and Philsophical Studies. Singer published The Life You Can Save in 2009.

 

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The Daily Impact: Report warns of US global health funding decline

March 28, 2014

A new Global Health Technologies Coalition report says while big budget battles in Washington may be over for now, adequate funding to fight HIV, TB, malaria and other diseases may still be at risk. From VOA:

Coalition Director Kaitlin Christenson praises the improved atmosphere between Democrats and Republicans. She called the ceasefire in budget debates on Capitol Hill “good news.”

“We’re pleased to see that for the first time in several years Congress is able to move forward with a budget that went through the relatively normal process. And we’re pleased to see that in many areas numbers for global health specifically were held strong,” she said.

The federal budget had gone though – what’s called – sequestration.  It required mandatory across-the-board cuts for all agencies if Congress failed to make its own spending cuts. In recent years, the legislative body could not reach agreement, so all agencies took a big hit in spending.

Christenson said while the climate has improved, there are no guarantees of agreement for the next fiscal year beginning in October.

“Going into negotiations for FY-15 we do have some concerns and are hoping that Congress will – as it takes the president’s budget request – bring numbers back up for agencies like the NIH [National Institutes of Health], like global health programs at the State Department and at USAID.”

She said the National Institutes of Health and the U.S. Agency for International Development play a critical role in researching and developing health-related products, simply known as R&D.

With USAID and the State Department, in particular, we saw that funding levels were for the most part decreased across all conditions and disease areas based on the levels that were approved by Congress for the FY-14 budget agreement.

It’s a similar situation for the National Institutes of Health.

Christenson said, “With the NIH, the president’s request for FY-15 was still lower than the request that came in in 2014. It’s a slight increase over what we saw passed by Congress, but the budget request coming from the administration has actually decreased. There’s critical research happening at the NIH that helps us understand how these diseases take place – and helps propel the development of new products that are desperately needed.”

Before sequestration began in March of last year, many research projects were underway. Many millions of dollars had already been spent on them. When the cuts took hold, the projects simply shut down.

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What are the Best Buys in Global Health for 2014?

IMG_5641For this issue of Impact magazine, Devex, Merck for Mothers and PATH joined PSI and a team of experts to uncover some of global health’s best investments. The answers were as complicated as they were interesting.

Inspired by a Devex survey of more than 1,000 health experts working in a variety of settings around the globe, we set out to identify global health trends, as well as barriers and solutions to scaling up promising interventions.

Our research suggests that as important as new technologies are for tackling entrenched and emerging health challenges, it is even more important to strengthen health systems in the developing world and build local capacity there. After all, it’s people who implement the innovations and health systems which drive impact.

 

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The Daily Impact: Global effort stumbles in Malaria Fight

March 27, 2014

A new report in CNN describes how resistance to artemisinin is cause for concern regarding the global effort to control malaria.  An excerpt:

Malaria is the work of the single-celled Plasmodium parasites, and Plasmodium falciparum chief among them. They spread between people through the bites of mosquitoes, invading first the liver, then the red blood cells. The first symptoms are generic and flu-like: fever, headache, sweats and chills, vomiting. At that point, the immune system usually curtails the infection. But if the parasites spread to the kidneys, lungs and brain, things go downhill quickly. Organs start failing. Infected red blood cells clog the brain’s blood vessels, depriving it of oxygen and leading to seizures, unconsciousness and death.

When Nosten first arrived in Southeast Asia almost 30 years ago, malaria was the biggest killer in the region. Artemisinin changed everything. Spectacularly fast and effective, the drug arrived on the scene in 1994, when options for treating malaria were running out. Since then, “cases have just gone down, down, down,” says Nosten. “I’ve never seen so few in the rainy season — a few hundred this year compared to tens of thousands before.”

But he has no time for celebration. Artemisinin used to clear P. falciparum in a day; now, it can take several. The parasite has started to become resistant. The wonder drug is failing. It is the latest reprise of a decades-long theme: we attack malaria with a new drug, it mounts an evolutionary riposte.

Back in his office, Nosten pulls up a map showing the current whereabouts of the resistant parasites. Three colored bands highlight the borders between Cambodia and Vietnam, Cambodia and Thailand, and Thailand and Myanmar (Burma). Borders. Bold lines on maps, but invisible in reality. A river that can be crossed in a rickety boat is no barrier to a parasite that rides in the salivary glands of mosquitoes or the red blood cells of humans.

History tells us what happens next. Over the last century, almost every frontline antimalarial drug — chloroquine, sulfadoxine, pyrimethamine – has become obsolete because of defiant parasites that emerged from western Cambodia. From this cradle of resistance, the parasites gradually spread west to Africa, causing the deaths of millions. Malaria already kills around 660,000 people every year, and most of them are African kids.

If artemisinin resistance reached that continent, it would be catastrophic, especially since there are no good replacement drugs on the immediate horizon.

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The Daily Impact: Air Pollution Claims 7 Million Lives a Year – WHO

March 26, 2014

The WHO released a new report estimating that 7 million people die each year due to air pollution. From the AP:

The agency said air pollution is the cause of about one in eight deaths and has now become the single biggest environmental health risk.

“We all have to breathe, which makes pollution very hard to avoid,” said Frank Kelly, director of the environmental research group at King’s College London, who was not part of the WHO report.

One of the main risks of pollution is that tiny particles can get deep into the lungs, causing irritation. Scientists also suspect air pollution may be to blame for inflammation in the heart, leading to chronic problems or a heart attack.

WHO estimated that there were about 4.3 million deaths in 2012 caused by indoor air pollution, mostly people cooking inside using wood and coal stoves in Asia. WHO said there were about 3.7 million deaths from outdoor air pollution in 2012, of which nearly 90 percent were in developing countries.

But WHO noted that many people are exposed to both indoor and outdoor air pollution. Due to this overlap, mortality attributed to the two sources cannot simply added together, hence WHO said it lowered the total estimate from around 8 million to 7 million deaths in 2012.

The new estimates are more than double previous figures and based mostly on modeling. The increase is partly due to better information about the health effects of pollution and improved detection methods. Last year, WHO’s cancer agency classified air pollution as a carcinogen, linking dirty air to lung and bladder cancer.

WHO’s report noted women had higher levels of exposure than men in developing countries.

“Poor women and children pay a heavy price from indoor air pollution since they spend more time at home breathing in smoke and soot from leaky coal and wood cook stoves,” Flavia Bustreo, WHO Assistant Director-General for family, women and children’s health, said in a statement.

Other experts said more research was needed to identify the deadliest components of pollution in order to target control measures more effectively.

“We don’t know if dust from the Sahara is as bad as diesel fuel or burning coal,” said Majid Ezzati, chair in global environmental health at Imperial College London.

Kelly said it was mostly up to governments to curb pollution levels, through measures like legislation, moving power stations away from big cities and providing cheap alternatives to indoor wood and coal stoves.

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