n/a WHO and World Bank join forces for better results from global health investments
As delegates gather at the International AIDS Conference (3-8 August), the World Health Organization (WHO) and the World Bank today address the pressing global debate around health systems and initiatives in specific aspects of health, nutrition and population. Critics claim that disease-specific initiatives are eroding already weak health systems, while others assert that weak health systems are holding back progress in disease-specific initiatives. In an effort to gather evidence and provide technical guidance in this area, WHO and the World Bank have agreed to join forces in collaboration with a wide range of interested stakeholders including country officials, academic and research institutions, Global Health Initiatives and civil society organizations.
During the past decade, global health initiatives have become a prominent part of the international aid architecture, bringing new resources, partners, technical capacity and political commitment. Examples include The Global Fund to Fight AIDS, Tuberculosis and Malaria, the GAVI Alliance, and the US President’s Emergency Plan for AIDS Relief, known as PEPFAR. Now numbering more than 80, these initiatives have contributed to a dramatic increase in the level of resources for health in low- and middle-income countries.
Notwithstanding the gains that have been made in funding and access to health services, critics allege that Global Health Initiatives have also exposed weaknesses in health systems. These weaknesses in overstressed health systems in many low- and middle- income countries are thought to be limiting the effectiveness of Global Health Initiatives and may be undermining investments that are now being made. The new effort will examine the issues in the debate, separate reality from rhetoric, and provide governments with sound technical guidance to enhance health systems without diminishing the benefits of disease specific initiatives.
“It is not about choosing between health systems strengthening on the one hand and disease-specific programmes on the other,” said Dr Carissa Etienne, WHO Assistant Director-General, Health Systems and Services, at a press conference during the XVIIth International Conference on AIDS in Mexico City. "It is about working together to generate added value. The time has come to move from observing the intentional and unintentional impacts of health investments, to actively managing better outcomes that can be sustained.”
The WHO-World Bank collaboration will examine and combine the strengths of different approaches around the world in order to get better results from investments and improve health outcomes for all.
“This collaboration will be useful at the country and global levels. We will generate new knowledge, work with countries to improve their approaches and share lessons at the regional and global levels,” says Julian Schweitzer, Director of Health, Nutrition and Population at the World Bank.
n/a 3 million now receiving life-saving HIV drugs
The close of 2007 marks an important step in the history of the HIV/AIDS epidemic. Nearly 3 million people are now receiving anti-retroviral therapy (ART) in low- and middle-income countries, according to a new report jointly launched today by WHO, UNAIDS and UNICEF.
The report, Towards universal access: scaling up priority HIV/AIDS interventions in the health sector, also points to other gains. These include improved access to interventions aimed at preventing mother-to-child transmission of HIV (PMTCT), expanded testing and counseling, and greater country commitment to male circumcision in heavily affected regions of sub-Saharan Africa.
“This represents a remarkable achievement for public health,” said WHO Director-General Dr Margaret Chan. “This proves that, with commitment and determination, all obstacles can be overcome. People living in resource-constrained settings can indeed be brought back to economically and socially productive lives by these drugs.”
Millions now accessing treatment
According to the authors of the report, the close of 2007 saw nearly 1 million more people (950 000) receiving antiretroviral therapy—bringing the total number of recipients to almost 3 million. The latter figure was the target of the ‘3 by 5’ initiative that sought to have 3 million HIV-positive individuals living in low-and middle-income countries on treatment by 2005. Although that target was not achieved until two years later, it is widely credited with jump-starting the push towards ART scale-up.
According to the report, the rapid scale-up of ART can be attributed to a number of factors, including the:
Increased availability of drugs, in large part because of price reductions;
Improved ART delivery systems that are now better adapted to country contexts. The WHO public health approach to scale-up emphasizes simplified and standardized drug regimens, decentralized services and judicious use of personnel and laboratory infrastructure; and
Increased demand for ART as the number of people who are tested and diagnosed with HIV climbs.
Greater access: greater need
The authors state that overall, some 31% of the estimated 9.7 million people in need of ART received it by the end of 2007. That means that an estimated 6.7 million in need are still unable to access life-saving medicines.
“This report highlights what can be achieved despite the many constraints that countries face and is a real step forward towards universal access to HIV prevention, treatment care and support,” said Dr Peter Piot, Executive Director of UNAIDS. “Building on this, countries and the international community must now also work together to strengthen both prevention and treatment efforts.”
Preventing HIV in children
At the end of 2007, nearly 500 000 women were able to access antiretrovirals to prevent transmission to their unborn children — up from 350 000 in 2006. During the same period, 200 000 children were receiving ART, compared to 127 000 at the end of 2006. The difficulty of diagnosing HIV in infants, however, remains a major impediment to progress.
“We are seeing encouraging progress in the prevention of HIV transmission from mother to newborn,” said UNICEF Executive Director Ann M. Veneman. “The report should motivate us to focus and redouble our efforts on behalf of children and families affected by HIV/AIDS.”
Tuberculosis, weak healthcare systems, hamper progress
Other obstacles to scaling up treatment include poor patient retention rates in many treatment programmes and the considerable numbers of individuals who remain unaware of their HIV status, or are diagnosed too late and die in the first six months of treatment.
Tuberculosis is a leading cause of death among HIV-infected people worldwide, and the number one cause of death among those living in Africa. To date, HIV and TB service deliveries are insufficiently integrated and too many people are losing their lives because they are unable to either prevent TB or access life-saving medications for both diseases.
The authors warn that future expansion of access to ART is likely to be slow owing to weak health systems in the worst-affected countries, in particular, the difficulty of training and retaining health-care workers. Health-care systems in regions hardest hit continue to erode because of ‘brain drain’—the migration of skilled health-care personnel to other occupations and to other countries—and to high mortality rates from HIV itself.
They also emphasize the ongoing need to improve the collection, analysis and publication of critical public health information. Countries, international partners and other sources supply the numbers featured in this report. Despite certain limitations, the data constitute the best and most up-to-date estimates of the different elements of the health sector response to HIV/AIDS.
n/a Climate change will erode foundations of health
Scientists tell us that the evidence the Earth is warming is "unequivocal." Increases in global average air and sea temperature, ice melting and rising global sea levels all help us understand and prepare for the coming challenges. In addition to these observed changes, climate-sensitive impacts on human health are occurring today. They are attacking the pillars of public health. And they are providing a glimpse of the challenges public health will have to confront on a large scale, WHO Director-General Dr Margaret Chan warned today on the occasion of World Health Day.
"The core concern is succinctly stated: climate change endangers human health," said Dr Chan. "The warming of the planet will be gradual, but the effects of extreme weather events -- more storms, floods, droughts and heat waves -- will be abrupt and acutely felt. Both trends can affect some of the most fundamental determinants of health: air, water, food, shelter and freedom from disease."
Human beings are already exposed to the effects of climate-sensitive diseases and these diseases today kill millions. They include malnutrition, which causes over 3.5 million deaths per year, diarrhoeal diseases, which kill over 1.8 million, and malaria, which kills almost 1 million.
Examples already provide us with images of the future:
*European heat wave, 2003: Estimates suggest that approximately 70 000 more people died in that summer than would have been expected.
*Rift Valley fever in Africa: Major outbreaks are usually associated with rains, which are expected to become more frequent as the climate changes.
*Hurricane Katrina, 2005: More than 1 800 people died and thousands more were displaced. Additionally, health facilities throughout the region were destroyed critically affecting health infrastructure.
*Malaria in the East African highlands: In the last 30 years, warmer temperatures have also created more favourable conditions for mosquito populations in the region and therefore for transmission of malaria.
*Epidemics of cholera in Bangladesh: They are closely linked to flooding and unsafe water.
These trends and events cannot be attributed solely to climate change but they are the types of challenges we expect to become more frequent and intense with climate changes. They will further strain health resources that, in many regions, are already under severe stress.
"Although climate change is a global phenomenon, its consequences will not be evenly distributed," said Dr Chan. "In short, climate change can affect problems that are already huge, largely concentrated in the developing world, and difficult to control."
To address the health effects of climate change, WHO is coordinating and supporting research and assessment on the most effective measures to protect health from climate change, particularly for vulnerable populations such as women and children in developing countries, and is advising Member States on the necessary adaptive changes to their health systems to protect their populations.
WHO and its partners -- including the UN Environment Programme, the Food and Agriculture Organization, and the UN World Meteorological Organization -- are devising a workplan and research agenda to get better estimates of the scale and nature of health vulnerability and to identify strategies and tools for health protection. WHO recognizes the urgent need to support countries in devising ways to cope. Better systems for surveillance and forecasting, and stronger basic health services, can offer health protection. WHO will be working closely with its Member States in coming years to develop effective means of adapting to a changing climate and reducing its effects on human health.
"Through its own actions and its support to Member States," said Dr Chan, "WHO is committed to do everything it can to ensure all is done to protect human health from climate change."
20/02/2008 World Health Day 2008: protecting health from climate change
World Health Day, on 7 April, marks the founding of the World Health Organization and is an opportunity to draw worldwide attention to a subject of major importance to global health each year. In 2008, World Health Day focuses on the need to protect health from the adverse effects of climate change.
The theme “protecting health from climate change” puts health at the centre of the global dialogue about climate change. WHO selected this theme in recognition that climate change is posing ever growing threats to global public health security.
Through increased collaboration, the global community will be better prepared to cope with climate-related health challenges worldwide. Examples of such collaborative actions are: strengthening surveillance and control of infectious diseases, ensuring safer use of diminishing water supplies, and coordinating health action in emergencies.