According to the authors, achieving universal health coverage by 2030, as stated in UN Global Goal 3, will require substantial increases in health spending and the proportion funded through taxation or social insurance to make health care affordable for all. Not only will institutions need to be established to ensure sustainable arrangements for social finance, it will also be vital to ensure that health financing is resilient to economic and other shocks if Global Goal 3 is to be realised. This is argued to present a major challenge in Africa, where an economic downturn is projected in a number of resource-dependent countries, such as Mozambique and Guinea Bissau and where countries such as Sierra Leone have weakened health systems. The response to these challenges by governments and development partners, will have important effects on how well people, and the health services on which they rely, cope in the short term and longer-term evolution of health coverage.
Health equity in economic and trade policies
The emergence of an increasingly global economy suggests that the ability of individual countries to shape their own destinies is becoming more difficult. International trends and pressures now influence national, and even local, health care policy making. Researchers from the University of the Witwatersrand, South Africa, together with Oxford University, looked at the effect of globalisation on health issues in South Africa and assessed its influence compared to national and local forces.
Medical tourism involves patients intentionally leaving their home country to access non-emergency health care services abroad. This article reviewed academic articles, grey literature, and media sources extracted from 18 databases to examine what is known about the effects of medical tourism in destination and departure countries. It found that most of the 203 sources accepted into the review offer a perspective of medical tourism from the Global North only, focusing on the flow of patients from high-income nations to lower- and middle-income countries, biasing the findings. Five interrelated themes emerged: medical tourism was promoted as a solution to health system problems and a revenue-generating industry offering patients higher standard of care, but some studies criticised it for using scarce public resources and causing health inequity. The study concluded that what is currently known about the effects of medical tourism is minimal, unreliable, geographically restricted and mostly based on speculation. Additional primary research on the effects of medical tourism is needed if the industry is to develop in a manner that is beneficial to citizens of both departure and destination countries.
This report summarises the main themes, ideas and discussion points from the G20 Conference, held on 30 June 2010. The purpose of this conference was to explore options for the future for the G20 in advancing key issues in global health and development, set against a background of a G8 legacy of contributions to global health aid and the G20’s current focus on the economic crisis. Several themes emerged. First, the Global Fund noted it cannot meet its funding promises and is looking for contributors for the next three years. The Fund needs US$10 billion to sustain current levels, and $17 billion to continue to make gains in fighting HIV and AIDS, tuberculosis and malaria. The conference heard that there is a real possibility of eradicating polio in the next ten years, as just four countries still suffer from the disease, but this requires a concerted effort and political will. While it could be expensive, the long-term savings may be huge as people will no longer need to be immunised against the disease.
This discussion paper underlines a major risk in the Joint Africa-EU Strategy (JAES) implementation process so far: the perceived gradual dilution of the political substance of the new policy framework. This risk lies in contrast to the original negotiations for the JAES, where there was a much stronger commitment to negotiating political differences. It is reflected in the fact that the JAES finds it difficult (so far) to politically uplift the partnership ‘beyond Africa’, ‘beyond cooperation’ and ‘beyond institutions’. According to this paper, the dilution should be a matter of concern considering that the added value of the JAES, compared to existing policy frameworks such as the Cotonou Agreement or bilateral relations, precisely lies in its ambitious political agenda to renew and transform Africa- EU relations. Little tangible progress has been achieved in establishing the JAES as the overarching political framework for Africa-EU relations. Levels of ownership tend to be low beyond the inner circle of those concerned with the JAES. The paper argues that that the current difficulties experienced by the JAES are linked to fundamental political choices in the implementation strategies followed so far rather than to the validity of the overall vision underlying the search for a renewed Africa-EU partnership.
Aid for trade (AfT) has proved to be largely ineffective in Malawi because it has had limited success in developing the local human and institutional capacity required to enable trade, according to this article. A key contributor to this has been a failure by trade promoters and external funders to identify where Malawi stands on its development curve. AfT solutions have tended to assume that Malawi is on the same point on its development curve as Cambodia, Vietnam, Ghana or Rwanda. Yet Malawi simply does not have the scale of human capacity that is required to ensure a pro-poor business environment. It lacks the capacity to ensure businesses have affordable access to finance, business development services, inputs, information, markets, labour and technology. The core problem is that civil society, government and the development community have not adequately recognised the roles that development and trade play in their poverty reduction objectives, the author concludes.
Information Communication Technology (ICT) has revolutionized modern living, international business, global governance, communication, entertainment, transport, education, and health care. This has been driven by unprecedented high volumes of production and usage of consumer electronic products, in particular, personal computers, mobile phones, and television sets. Access to ICT has been identified as an indicator of a country’s economic and social development. The difference in access to ICT between developed and developing countries is commonly referred to as the “digital divide”. Africa has been undergoing rapid ICT transformation in recent years, attempting to bridge this divide by importing second-hand or used computers, mobile phones, and TV sets from developed countries. The countries of the region, however, lack the infrastructure and resources for the environmentally sound management (ESM) of electrical and electronic waste (e-waste) arising when such imports reach their end-of-life. The report analyses the flows of electrical and electronic equipment and e-waste and makes recommendations for African countries to prevent the import of e-waste and near-end-of-life equipment without hampering the socio-economically valuable trade of EEE of good quality.
At the World Health Assembly’s discussions on the patenting of viruses by drug companies, WHO admitted patents have been taken on the avian flu virus, and WHO collaborating centres have entered into Material Transfer Agreements with vaccine manufacturers. Various countries responded to the non compliance of the WHO’s 2005 Guidance on sharing viruses.
As countries rush to conclude bilateral and regional free trade agreements, there are growing concerns that these trade agreements could adversely affect the health policies of the developing countries. Against this backdrop, the WHO Executive Board has recommended that the next World Health assembly in May adopt a resolution on trade and health. Member States are asked to include health ministries in negotiations on trade agreements and the WHO Secretariat has been tasked to assist in this process.
The World Health Organisation (WHO) Executive Board has agreed to propose to the May 2012 World Health Assembly the establishment of a mechanism for international collaboration on counterfeit and substandard medical products, but with the exclusion of trade and intellectual property issues. The Executive Board resolution would “establish a new Member State mechanism for international collaboration among Member States, from a public health perspective, excluding trade and intellectual property considerations, regarding substandard/spurious/falsely-labelled/falsified/counterfeit medical products”. The next Assembly in May will decide on this resolution. The mechanism would be reviewed by the World Health Assembly after three years, and countries will submit a progress report after one year. A contentious issue around counterfeits has been the suspicion on the part of some developing countries that concerns about counterfeit and substandard medicines are being purposely confused with trade in legitimate generic medicines from those countries. Removing intellectual property and trade from WHO discussions is intended to minimise the possibility of confusion.