Day 1 summary from Joseph Ana

Joseph Ana, Nigeria

Date: Mon, 22 Oct 2012 08:06:16
To: HIFA2015 – Healthcare Information For All by 2015<HIFA2015@dgroups.org>
Subject: [HIFA2015] Day 1 from Canadian Global Health Conference in Ottawa

Dear All,

Day 1 at the Canadian Global Health conference delivered all that was expected from such a mega meeting: loads of learning points to fill gaps in my PIN (Practitioner Information Needs). The format as three plenary sessions and two breakout periods with concurrent sessions for participants to choose from. Both sessions are separated by tea breaks and lunch.

The opening plenary, 8.45 am to 10 am, was for ‘Setting the stage: Global Health in the Shifting World Economy’. The speakers Professor of Global Health, Washington University, Dean Jamison and Professor of Sociology, Columbia University, Saskia Sassen wetted our appetite for what lay ahead. That led me to choose to attend the concurrent symposium on ‘whither Global health in a shifting World Economy’ so as to continue on the subject of ‘health and economy’ (the other two were ‘Global health Research’ and ‘Global Health Education’). I chose health & economy, because in my country, the 2013 federal budget has just been submitted to the national assembly, and unfortunately for health sector it is bad news. Inspite of the comatose state of the health sector, and all the human resource, equipment and infrastructure waiting and calling for ’emergency resuscitation’ to save Nigerians, the allocation to health is about 6% (we know that the actual release will eventually be below 2%). I still don’t understand the budget planners in Nigeria!. Sorry, I must not deviate!

At the meeting there was a lecture titled ‘Sex, Death and Money’,  but the speaker Prabhat Jha, Chair of Disease Control, University of Toronto spoke only on ‘Death’ (at the end of his lecture, I think I heard murmurings of disappointment) with examples from India where poverty is still a major obstacle to improving that countries Health outcomes, even though the GDP has been enviable in recent years. No wonder India and Nigeria (and South Africa) share someting on the prevalence of AIDS. Nigeria like India is touted to be enjoying high GDPs but you only have to visit the rural areas in either country to ask, ‘Is the Economy stupid or is Health mad?’ Which one?.

During Q & A, I joined the cue to ask Prof Jamison who characterised USA health policy as ‘pro poor’ and that of Europe as ‘pro- Universal care’. I understood that the description of Health Policy in Europe but wanted him to throw more light on how USA health can be described as pro-poor’ and there are many millions of Americans without access to care (which I think is what Obamacare wants to correct). Well I could not ask my question because the session ran out of time. I may yet have time to ask him my question one-on-one before he conference closes.

My next session was the Peoples Health Movement (PHM) because I wanted to learn about it. My summary is that PHM is an activist group of lay and professional volunteers that arose from 2000 to fight for ‘health as a human right’, when Alma Atta declaration failed to deliver ‘Health for All’ in that year. It has succeeded in gaining reognition such that every year it hs representation at the World Health Assembly that follows the UN General Assembly. It sensitises the world on the impact that human activities (mining, politics, culture, religion, social changes, gender, abuse, aging & elderly, environment, etc) have on health of the people. From its meeting in Ecuador in 2009 started the ‘International Peoples Health University’ (IHPUs). Don’t be carried away these are not aceademic universities as we know them. IHPUs are 10-day intensive, live-in experiences that are case study oriented in various regions of the world. The Latin American region one discusses ‘mining and health’ because it has huge relevance in that region.

HIFA2015 members can join PHM at http://groups.google.com/group/mps-phm-canada or at phmovement.org

At these mega global meetings ,one is fortunate to meet heroes and heroines of the yester-years of ‘Health in Nigeria’ especially during the peri-indepence period which was truncated by the milatary and the concomittant Biafra Civil War. At the second plenary in Ottawa Professor Brian M. Greenwood, Canada Gairdner Global Health Award winner, and emeritus of the University of Ibadan and Ahmadu Bello University, Zaria, and formerly of MRC, The Gambia delivered an eponymous Gaidner lecture titled: ‘Pnuemonia: A Neglected Problem in African Children’. In summary – Pneumonia kills more children than malaria but it has not received anywhere near the attention that its deadly cousins AIDS, Malaria and Tuberculosis (AMT). The Global Fund has done a lot to tackle AMT but not so pneumonia. He mentioned his experience in Nigeria and mentioned several of his contemporaries that gave Nigeria its golden years in Health, yet: Eldryd Parry, Late David Morley and Pearson. One of them, Professor John Owen as present and asked questions. I acknowledge the achievements of these expatriates to Nigeria’s health and topped it with a question on ‘what is being done to bring down the price of the vaccines as was done for antiretroviral drugs and ACTs?’. Apparently that is under discussion!. In my experience, as with AIDS and Malaria a significant reduction in pnuemococcal vaccine price will deal the same blow to killer pneumonia, alonside other measures like improved cooking stoves, preventing passive smoking (hopefully children don’t smoke), increased micronutrients in nutrition for children (zinc, vit A & D), training Community Health workers on rational antibiotics use, etc, etc. The lecturer acknowledged that the pionering work on the huge impact of pneumonia started in Papua New Guinea many years before the MRC in the Gambia. Prof Greenwood did an excellent job in taking the audience along his line of advocacy, judging by the ovation that followed his lecture.

Before Greenwoods lecture, I attended a concurrent symposium where several groups described their various interventions, mostly in Africa (Ghana, Ethiopia, Mlawi, Zimbabwe, Maozambique, Mali) but also in Asia (Pakistan, Bangladesh) supported by CIDA.

The day ended with a cocktail reception but before it we networked according to the subregions of choice. I joined the west africa group and met many colleagues in Global Health. We have exchanged notes on our activities in our countries and hope to follow up when we return.

If Day 1 was like this, top class in every conference evaluation parameter, I can’t wait for Day-2.

Joseph Ana, Nigeria

Day 2 Summary from Joseph Ana

Date: Tue, 23 Oct 2012 07:53:37
To: HIFA2015 – Healthcare Information For All by 2015<HIFA2015@dgroups.org>

Dear all,

This update is delayed because, surprise, surprise the internet ‘failed’ to connect during most of Day 2 in the hotel. I wondered if I brought the gremlin with me. but as you can see it has been sorted and we are back to broadband again.

Day 2 at the Canadian Global Health conference was as action-packed as the first day and as instructive and exciting. The organisation and all other evaluation parameters remain excellent. Thanks to the organisers: Julia Sanchez, Sarah Brown, and many others whose names I may not know yet. The co-Chairs of the Conference LOC, Janet Hatcher Roberts and Shree Mulay deserve special mention too. Of course there cannot be a conference without the multitude of participants, volunteers, speakers and poster presenters, including the key note plenary speakers. The arrangement is such that going from one event to the other, on different floors, in this magnificent hotel, Delta City Centre, is seamless and smooth.

Day 2 started with a formal opening speech by Hon Julian Fantino, minister of International Cooperation who re-emphasised Canada’s commitment to Global Health especially by supporting Public Private Initiatives in Health; strengthening Health systems; supporting measures to sustaining the drop in maternal and child mortality; etc.

The first Plenary which followed his speech was chaired by Julia Sanchez and there were five keynote lectures:

 – Jon Kim Andrus of PAHO on ‘From Declaration to multi-stakeholder Action: PAHO’s perspective on partnerships- he described the structure of PAHO and the formation of Pan American Forum for Action on NCDs.

– Irene Klinger of PAHO on ‘Harnessing multi-stakeholder action to combat chronic disease in the Americas- described the participation of PAHA at the UN High Level Meeting on NCD in Sept 2011. She [said] that smoking continues to be a major challenge for NCD action because 35% of teenage girls in Chile for instance smoke cigarette, and this is inspite of high cost and ugly packaging!

– Alex Palacios of GAVI Alliance on ‘Saving Lives and Improving health through partnership and Innovation’- said that UNICEF had just released the good news that Under-5 mortality has just dropped below 7 million per year for the first time!. New targets have been set e.g. 80% access to vaccines by 2025. But the bad news is that up to 20% of children are still vulnerable to preventable diseases.

– Celina Gore of Global Alliance on Chronic disease on ‘Innovative Partnerships for Global Health Research’- described the work of Global Alliance for Chronic Disease (GACD) based in London, advocated that the research community need to work with Private sector to achieve the NCD objectives.

 – Mark Fryars of Micronutrient Initiative on ‘The role of SUN movement in increasing multi stakeholder efforts to improve nutrition’- described what the SUN movement is and what it has been doing to improve nutrition especially micronutients – zinc, vit A & D , iodised salt, etc. He advocated a multi sectoral approach to the issue of nutrition.

The first breakout session that I attended continued with the theme of NCDs and the speakers emphasised the points made during the plenary. Essentially, NCDs (non communicable diseases) have overtaken infectious diseases and injury as the major killer worldwide. But for me, right from 2010, when Richard Smith, former BMJ Editor higlighted this fact at a BMJ West Africa Workshop in Abuja, Nigeria, I have wondered why that is the case in LICs. In LICS the life expectancy is dropping not increasing; obesity is not as common as in HICs because of malnutrition and other factors; smoking is not as common as in the west; alcohol is over consumed by a small part of the population.These are all common causes of NCDs in the West unlike in the poor countries. The indigenous communities in Canada and the aborigines in Australia have these factors as to suffer NCDs but what about the LICs ? We are told that poverty is the cause but that does not expalin it? I welcome any clarification on this conundrum.

The second breakout session was on Access to to healthcare and we listened to six short reports on what is being done in various countries on this: Ghana, DEnmark, (using sms to convey advice to NCD patients in Gabon); Social health insurance in Ghana and its challenges; Access to emergency obstetric care and its catsatrophic effect on the poor; Disfunctional pharmacy services in failing health systems.

The third breakout session was on ‘retention of health workers in subsaharan africa: reform to inform policy’. There were four speakers from research in Malawi, Zambia, Burkina Faso and Mali. Their reports generated very exciting discussion and suggestion to ‘take Home’.

The Day came to an end with a buffet dinner with background music (Paul Simon’s Graceland album!).

 Our appetite is surely wetted for Day 3.

Joseph Ana, Nigeria

Scholarship, Activism, Politics and Economics

Scholarship, Activism, Politics and Economics: Intersecting Global Health Themes 

Tuesday, October 23^rd, 2012

This session was chaired by Genevieve Dubois-Flynn, Manager and Senior Advisor, Ethics Office, Canadian Institute of Health Research.

Susan George (Transnational Institute, Honorary President, Association for Taxation of Financial Transactions to Aid Citizens) joined the session by Skype for Paris, France.  She highlighted several areas of “good news” and “bad news”, including:

• In the area of hunger, the number of seriously malnourished children is down by about 35 percent since 1990. However, 36% of all African children and 27% of all Asian children are severely malnourished. Also, while the number of underweight children is down in the South, childhood obesity is an increasingly serious problem.
• The scarcity of clean drinking water worldwide is a major cause of illness and disease. Although it is feasible to get clean water to everyone that lacks it, we are not making the expenditures necessary to achieve this.
• The airline tax collected by UNITAID is making inroads in the area of HIV/AIDS, malaria and tuberculosis.
• Structural adjustment programs continue to have a lasting impact in Africa. The global financial crisis in European countries – including Spain, Portugal and Greece – is now fueling a health crisis.
• Climate change is having an impact on health. Diseases that we consider “tropical” are moving north.

Dr Susan Horton (Associate Provost, Graduate Studies and GICI Chair in Global Health Economics, University of Waterloo) spoke about the extent to which economic growth has a positive effect on global health and shared some “good news”/”bad news” stories:

• She explained that height is a sensitive indicator of nutritional status and economic growth has a positive effect on height. For instance, the proportion of children that are stunted is going down around the world – however, the least benefit can be seen in Africa.
• Also, the number of child deaths under age 5 has declined globally since 1960, but the same decline can not bee seen in sub-Saharan Africa.
• Life expectancy is increasing globally, but is lower in sub-Saharan Africa. HIV/AIDS, state failure, war, and genocide reversed some gains. But now that more and more resources have been directed to HIV/AIDS, the adverse trend is now being reversed, and life expectancy is starting to increase again.

In addition to economic growth, a large infusion of funding into global health – particularly HIV/AIDS, and the Global Fund for AIDS, tuberculosis and malaria – has played an essential role in improving global health. The US is the largest donor in the area of global health. Other initiatives, including the UNITAID airline tax, funding from the private sector (e.g., Gates Foundation), funding for innovations, such as Grand Challenges, have also been helpful. Dr. Horton explained that she has been involved in initiatives to increase global funding for nutrition.

Dr. Salimah Valiani (Policy Analyst and Economist of the Ontario Nurses’ Association; Associate Researcher with the Centre for the Study of Education and Work, University of Toronto)discussed the undervaluing of caring labour, the export of nursing labour and the implications for human development. The movement of nurses (for example, from the global south to the north) has implications for human development.  The United States is the largest net receiver of internationally trained nurses. Canada and Australia also receive many internationally educated nurses (but are also losing nurses). Nurses migrate for various reasons including better wages, better working conditions, and also because of the persistent undervaluing of nursing and other care in labour. There is a significant loss of health labour from the African continent and from other parts of the global south. This results in severe shortfalls of health professionals. Governments in the global south often support the export of their nurses because they are interested in the remittances that are sent home. Remittances have increased dramatically over the last decade and are a new form of development for some countries (e.g., the Philippines). In the Philippines, there is even a legal requirement for those leaving for temporary work to remit.

A lively discussion took place following the presentations. The importance of scholars linking their work to activism was discussed. Activism needs to be supported by scholarship. The importance of programs/funding to encourage social innovations was also discussed.

Prepared by Jennifer Kitts

Mentorship in Global Health Research

Tuesday

Mentorship in Global Health Research: Experience of university-based Canadian Coalition for Global Health Research Pilot Program – Vic Neufeld, Jennifer Hatfield, Sheila Harms, Donald Cole

I was happy to learn about the global health research mentorship pilot coordinated by the Canadian Coalition for Global Health Research. Three Canadian universities (McMaster University, University of Toronto and University of Calgary) were part of this pilot, using different approaches to execute a mentorship program for post-doctoral students and junior faculty within their institutions. As described in the session, the program was initiated to overcome some of the challenges experienced by individuals starting a research career in global health. Because global health research is a relatively new field, funding and career tracks can be a bit uncertain. In addition, this area of study requires a board understanding of research and access to networks that can be difficult to tap into.

It was interesting to see that the three schools were so varied in their respective approach to their programs. Both the University of Toronto and McMaster University used different group mentorship strategies, whereas the University of Calgary did some one-on-one mentoring which facilitated student mentoring networks. I really liked the concept of student mentoring. Global health is such an interdisciplinary field of research, so it is conceivable that students may be overwhelmed with decisions for classes, research projects, internships, etc. Having the opportunity to learn from someone with similar interests and aspirations who has gone through the process would be a valuable experience. I’ve found mentors to be strong motivators and can help validate academic/career goals and direction. Furthermore, providing students with the opportunity to develop their leadership skills as student-mentors is an asset for their own career development. 

I feel that mentorship programs are valuable in any capacity and can help prepare students for some of the realities of working in the field of global health. One of the most valuable components of this mentorship program is definitely the networking opportunities available to students and junior faculty. I hope this program will continue beyond the pilot and expand to other universities across the country.

By Megan Duncan

Retention of Health Care Workers in Sub-Saharan Africa

Monday Symposia

Retention of Health Care Workers in Sub-Saharan Africa
Cheick Oumar Bagayoko, Hastings Banda, Fastone Goma, Séni Kouanda, Sumeet Sodhi

The Retention of Health Care Workers in Sub-Saharan Africa session began with acknowledging the overwhelming shortage of human resources for health. To provide some context, there is an average of 2.3 health workers for every 1000 people in Africa and 57 countries in a state of human resources for health crises, with no change in this between 2006 and 2011. The migration of health workers has been devastating for health systems in Sub-Saharan Africa. In response to the overwhelming need for health workers, the panellists discussed the results of their investigations of varying approaches and challenges for retaining health worker in Sub-Saharan Africa. Some of the key questions of these investigations included “What are the changing needs of the people?”, “What are the most pressing health needs?”, “What competencies are needed to meet these needs?”, “What are the systems that need to be in place?” and “Who needs to provide these services?”.

Formal and informal strategies were evaluated for the recruitment and retention of health workers. Methods such as incentive allowances and continuing education were assessed for their ability to retain staff.  The ‘rural hardship allowance’ in Zambia scored favorably among the health workers involved in the study conducted by the University of Zambia. I found it interesting to learn that while financial incentives are a powerful retention strategy, they are not as effective as one would assume. The challenge with allowances is their erosion over time because they aren’t increasing with inflation.

Interestingly, ‘human relationships’ was such a strong factor for staff retention. Important human relationships were those in the work environment, particularly the relationships between workers and their supervisor, and the relationships that workers had with the people in the village. The better the relationships; the more inclined the workers were to stay in the village. This discussion really brought to light for me the importance of good communication between workers and supervisors.

Continuing education also proved to be a valued retention strategy. Some of the results showed that workers were appreciative of opportunities to continue to enhance their level knowledge. Not only can certificates help health workers get promotions, it is also a method for affirming their knowledge, reducing their desire to leave.

One of the more holistic strategies discussed was the need to use a multi-sectorial approach to increasing social amenities in remote villages, primarily information and communication technologies that allow workers to stay connected. I hadn’t considered private telecommunications companies to be key stakeholders in the mission to retain health workers.

By Megan Duncan

Sustainable Development and Health

Monday Symposia

(PDFs of the powerpoints can be found at: http://www.ccgh-csih.ca/csih2012/presentations.php

Sustainable Development and Health – Blake Poland, Nick Previsich, Howard Hu, Donald Cole

I had not planned on attending the session on Sustainable Development and Health, although I was very happy that I did. Four compelling presenters spoke of the benefit and continued need for collaboration across disciplines and sectors to advance and maximize public health and development efforts. Public health approaches such as One Health and EcoHealth set the stage for discussing the harsh realities of environmental health in the developing world. Topics such as climate change, agriculture and mining were at the forefront in the four presentations.

One of the statements that continued to resonate with me after the session came from Blake Poland from the University of Toronto – “There is a growing disconnect between recognizing what’s wrong and being able to do anything about it”. It felt like a shot in the gut. Then the same sentiment was echoed by Howard Hu when discussing the rapid growth of the mining industry. Dr. Hu noted that science cannot keep up with tracking and monitoring exposures. He also made note of the devastating (my word, not his) gap between research and policy. These observations emphasized the growing need to close the gap in the exposure-to-intervention loop. Integrating knowledge and resources across sectors and disciplines will be integral in that in process. These comments also demonstrated the growing need for individuals working the field to be interdisciplinary entities in themselves.

I’m happy to stay the thought provoking session wasn’t all doom and gloom. As Dr. Poland reminded us, “The silver lining is that social change can be as unpredictable and swift as ecological change”.

By Megan Duncan

Access to Healthcare and Medicines in the Shifting Global Economy

Access to Healthcare and Medicines in the Shifting Global Economy

Monday October 22, 2012

This session was chaired by Kofi Barimah, of the Catholic University College of Ghana.

Professor Joseph Mensah of York University began by highlighting that the financial crisis – from the collapse of the Lehman Brothers to the Greek debt crisis – is affecting the African economy. Global health inequities are significant, and Sub-Saharan Africa is bearing a disproportionate global burden of disease.

A number of external factors affect access to health care in Africa. The financial crisis, for instance, is having an impact on donor funding. Professor Mensah pointed out that the United Kingdom, Belgium, Switzerland, Ireland, and others, have reduced funding to various African nations. Significant drops in commodity prices, including drops in oil prices, also have a significant effect on oil producing countries (such as Nigeria, Angola, Ghana and Uganda). Downward trends in national revenue affect access to health care. Tourism and remittances (a major source of income for sub-Saharan Africa) have also been affected by the financial crisis and have led to reduced access to health care and medicine. Professor Mensah explained that cutbacks mean that available resources must be used creatively. Also, African countries need to increase their funding toward the health sector, as outlined in the Abuja Declaration of 2011 in which they pledged to increase government funding for health to at least 15%.

Dr. Jeffrey Turnbull of the Ottawa Hospital began his presentation by explaining that the Canada Health Act is government by a number of principles: comprehensiveness; universality; accessibility; portability; and public administration. Health care is a provincial responsibility and the federal government gets involved by virtue of its spending power.

Dr Turnbull highlighted a number of ways in which the principles of the Canada Health Act are not being met. With respect to comprehensiveness, for instance, Canada’s system prioritizes hospital-based care, and doesn’t provide for pharmacare, dental care, vision care, long term care and home based care. Among OECD countries, Canada ranks in the lower third in terms of value for dollar spent. Canada doesn’t really have a comprehensive system. In terms of universality, vulnerable populations do not receive the same level of care in Canada because of geography, illness, and vulnerability (including ethnicity, poverty, and culture). Accessibility is also a challenge – indeed, five million Canadians do not have access to a family doctor.

Dr. Turnbull said that it is a challenge to transform the health system, particularly at a time when the federal government is abandoning the field of health care. The federal government should be facilitating innovation, and should be a strong national voice. It should also be focusing on healthy communities, and not cutting social services, including housing, schools, and social services for vulnerable populations. Only  25% of health is explained by the health care system, while 75%  is shaped by the social determinants of health.  Canada also needs effective governance and management, and to ensure that money invested leads to effective outcomes. Scarce resources need to be used in accountable ways.

Dr. Orvill Adams, of Orvill Adams & Associates, spoke about a number of dimensions related to assessing access to health services. To what extent is there a good “fit” between the clients and the health system? There are a number of dimensions related to access including: availability; geographic accessibility; affordability; and acceptability.  There can be barriers with respect to each of these dimensions. Other barriers include the failure to deliver integrated services, lack of health awareness, staff absenteeism, and so on.

Dr Adams emphasized that there is limited access to services for the poor – the poor are pushed further into poverty due to ill health. Furthermore, the poor have little power to demand quality health services.  Primary health care is supposed to be pro-poor but in most countries with weak health care systems, doctors don’t want to work in the poorly paid primary care system. Many health workers also prefer not to work in remote and rural areas.

Dr. Adams pointed out a number of demand and supply side strategies to improve access.

Supply side strategies include: emergency transportation; better staffed peripheral health facilities; culturally sensitive health care delivery and improved management, including supervision and feedback mechanisms. Dr. Adams emphasized that good management is key.  There are also financial intervention that can improve access including health insurance subsidies for the poor; pre-payment schemes; needs-based financing and the abolishment of user fees.

Dr. Adams also emphasized that the broader determinants of health are key to improving health. Improving access leads to improved utilization but not necessarily improved health.

The session concluded with a lively discussion, and a number of questions and comments.

Prepared by Jennifer Kitts

Sunday afternoon sessions: Canadian capacities in global health

Capacity Building for Healthy Communities – Dia Sanou, Jill Allison, Jalpa Shah, Rabia Bana

I was so inspired by the initiative and dedication of the panellist in the Capacity Building for Health Communities session. It was moving to see some of the great work being done at the local level. The projects that were presented ranged from training institutes for public health agriculture to a community clinic providing maternal health services to HIV/AIDS awareness among high right populations. It was helpful to hear about the varying implement strategies and some of their ‘lessons learned’ from their field work experiences.

One of the limitations of grass-roots programs is their long-term ability to sustain without external funding and support. Throughout the session a couple of the presenters discussed the challenges they faced trying to work with local health authorities and Ministries of Health to integrate the program into the health system. One project however engaged the Ministry of Health from the onset of the initiative. In this case, the Ministry of health was able to use the results of the study to help inform decision making. Where feasible, it’s useful to engage the decision maker from the onset as it gives the researcher the opportunity to learn which factors are important in the decision making process and can attempt to capture this in their data collection.

I was very intrigued by the group of student who presented from the University of Toronto’s Students for International Development (weblink for SID: http://www.sidcanada.org/). Each student presented on a specific capacity building project which they implemented as interns in Maragoli, Kenya. What I liked most about this program is that each student implemented a project with a difference focus, but all in the same community. I thought this was a great way to integrate a horizontal approach to research and health system strengthening. 

By: Megan Duncan

Whither Global Health in a Shifting World Economy

Sunday Symposia:

Whither Global Health in a Shifting World Economy – Professor Prabhat Jha, Professor Dean Jamison and Professor Anita McGrahan

What did we learn from 200 years of public health? This was Professor Jha’s opening question to the participants of the Whither Global Health in a Shifting World Economy session. Jha’s response to this question was that the increase in life expectancy has been attributed to the scale-up of public health interventions. The three panellist of this session consistently spoke of the valuable role that innovative technologies have played in promoting health. Professor Jamison observed that the development of powerful, low-cost health technologies have been the driver of change for human health. A number of the types of health technologies and e-health services that were being referred to can be seen in the WHO’s 2011 Compendium of new and emerging health technologies (Link to Compendium: http://whqlibdoc.who.int/hq/2011/WHO_HSS_EHT_DIM_11.02_eng.pdf).

What I found quite interesting about the presentations was the subtheme of access – access to new technologies and technologies for mobilizing access. While thinking about this question, I was reminded of a recent Lancet article Technologies for Global Health (link to article: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61273-2/fulltext). The article discusses the value of innovative health technologies if those who need them can’t access them.

Economic and health policies play a critical role in who can access health services. As we know, regulations such as TRIPS can prevent LMIC from accessing state of the art treatments and vaccines. In response to some of these policy related challenges, Professor Jha provided the example of the Affordable Medicines Facility – malaria (AMFm) (hyperlink: http://www.theglobalfund.org/en/amfm/), an innovative financing mechanism which subsidies malaria treatment. The AMFm is also showcased in the abovementioned Lancet article along with the ColaLife project (hyperlink to youtube video describing ColaLife: http://www.youtube.com/watch?v=engpDwK9YcA&feature=endscreen&NR=1). I like the ColaLife model because it capitalizes on an established and effective distribution system to provide remote communities with access to health services. These are just a couple examples of the types of innovative opportunities for improving access.

In her presentation, Professor McGahan referred to the bottom line in health as “reducing costs while raising health”.  I find initiatives such the AMFm and ColaLife particularly compelling because they do just that. They also serve as a reminder that innovative technologies, not simply money, will be required to sustain the progress that has been made in global health. Innovation in technology becomes increasingly important in a time of greater need with fewer resources.

By: Megan Duncan