Last week, I participated in the 16th World Conference on Tobacco or Health (WCTOH) in Abu Dhabi--a scientific event where the latest developments in tobacco control were presented.
The past few decades have seen enormous changes in the global burden of disease. Although many people, especially those living in (or near) poverty and other privations, are familiar with heavy burdens and much disease, the term “global burden of disease” emerged in public health and in health economics only in recent decades. It was coined to describe what ails people, when, and where, and just as reliable quantification is difficult, so too is agreeing on units of analysis. Does this term truly describe the burden of disease of the globe? Of a nation? A city?
As international donors gather this week in Brussels to mobilize resources for Guinea-Bissau, the government and people of this West African nation appear ready for a fresh start.
On March 5, Liberian physicians discharged Beatrice Yardolo, an English teacher, from the hospital, hoping that she would be their last Ebola patient. Unfortunately, last Friday another person in Liberia tested positive for the disease that has killed more than 10,000 people in West Africa.
The bad news was a reminder that the world must remain vigilant and insist that we get to zero Ebola cases everywhere. We also must support Guinea, Liberia, and Sierra Leone in their efforts to build back better health care systems to prevent the next epidemic.
Beatrice survived Ebola, but she and the other survivors have paid dearly because of the outbreak. She lost three of her 10 children to Ebola, her home was encircled in quarantine, and she’s been unable to work. She and her country face a daunting road back to recovery and they remain at risk of Ebola as long as there is a single case in the region.
Heather Lanthorn describes the design of the Affordable Medicines Facility- malaria, a financing mechanism for expanding access to antimalarial medication, as well as some of the questions countries faced as they decided to participate in its pilot, particularly those related to risk and reputation.
I examine, in my never-ending thesis, the political-economy of adopting and implementing a large global health program, the Affordable Medicines Facility – malaria or the “AMFm”. This program was designed at the global level, meaning largely in Washington, DC and Geneva, with tweaking workshops in assorted African capitals. Global actors invited select sub-Saharan African countries to apply to pilot the AMFm for two years before any decision would be made to continue, modify, scale-up, or terminate the program. One key point I make is that implementing stakeholders see pilot experiments with uncertain follow-up plans as risky: they take time and effort to set-up and they often have unclear lines of accountability, presenting risk to personal, organizational, and even national reputations. This can lead to stakeholder resistance to being involved in experimental pilots.
It should be noted from the outset that it was not fully clear what role the evidence from the pilot would play in the board’s decision or how the evidence would be interpreted. As I highlight below, this lack of clarity helped to foster feelings of risk as well as a resistance among some of the national-level stakeholders about participating in the pilot. Several critics have noted that the scale and scope and requisite new systems and relationships involved in the AMFm disqualify it from being considered a ‘pilot,’ though I use that term for continuity with most other AMFm-related writing.
In my research, my focus is on the national and sub-national processes of deciding to participate in the initial pilot (‘phase I’) stage, focusing specifically on Ghana. Besides being notable for the project scale and resources mobilized, one thing that stood out about this project is that there was a reasonable amount of resistance to piloting this program among stakeholders in several of the invited countries. I have been lucky and grateful that a set of key informants in Ghana, as well as my committee and other reviewers, have been willing to converse openly with me over several years as I have tried to untangle the reasons behind the support and resistance and to try to get the story ‘right’.
Each year on March 22 we mark World Water Day. It is an opportunity to keep the urgent water issues – from lack of sanitation to transboundary water to climate change -- top of my mind for practitioners, decision makers and the global public. In the coming days we will post here updates and stories from the field, as well as links to some of our partners’ content. But, more importantly, this is an opportunity to hear from you, too.
Anne Mutua is not your typical reality TV show contestant.
As President of the Steering Committee for Cameroon’s Health Sector Support Investment Project, I was pleasantly surprised by the innovative character of the Performance-based Financing (PBF) approach; and by its transformative potential.