The Sentinel

Human Rights Action :: Humanitarian Response :: Health ::
Holistic Development :: Sustainable Resilience
Week ending 25 October 2014

This weekly digest is intended to aggregate and distill key content from a broad spectrum of practice domains and organization types including key agencies/IGOs, NGOs, governments, academic and research institutions, consortiums and collaborations, foundations, and commercial organizations. We also monitor a spectrum of peer-reviewed journals and general media channels. The Sentinel’s geographic scope is global/regional but selected country-level content is included. We recognize that this spectrum/scope yields an indicative and not an exhaustive product. Comments and suggestions should be directed to:

David R. Curry
Editor &
Founding Managing Director
GE2P2 – Center for Governance, Evidence, Ethics, Policy, Practice

pdf verion: The Sentinel_ week ending 25 October 2014

blog edition: comprised of the 35+ entries posted below on 26 October 2014

Opinion: The long-term cure for Ebola – An investment in health systems :: Ellen Johnson-Sirleaf, President of Liberia

Opinion: The long-term cure for Ebola – An investment in health systems
by Ellen Johnson-Sirleaf, President of Liberia
Washington Post, 19 October 2014

As the Ebola nightmare continues in Liberia and as we battle to contain the epidemic, it is important to look beyond the immediate crisis. Many more lives will be lost before this dreadful outbreak is beaten, but to properly honor the memory of the victims we need to ask how it happened in the first place and, more pressingly, how we can prevent it from happening again.

After 30 years of brutal civil and political unrest, Liberia was a nation reborn. We transformed our country from a failed state into a stable democracy, rebuilding its infrastructure and its education and health systems, and enjoying one of the most promising growth records in Africa. Then Ebola swept in, threatening to tear apart that progress. It is a terrifying reminder of the destructive power of infectious disease, one all the more devastating given how far Liberia has come.

Without a doubt, part of the reason for this situation is that, with the exception of Doctors Without Borders, the initial international response to this emergency was markedly slow. This gave Ebola the time it needed to overwhelm our already-fragile health infrastructure.

President Obama has since committed to sending up to 4,000 military personnel to West Africa to set up much-needed health-care facilities and to train health-care workers, and last week he authorized the use of additional reserves, if needed. This will help our efforts to contain the outbreak, and we are truly thankful.

Similarly, a suitable vaccine and treatment for Ebola could have helped prevent this outbreak from getting out of control. And, indeed, efforts to fast-track the development of a promising candidate vaccine could potentially help to bring this all to a swifter end, even if initially there were only enough doses to vaccinate health workers on the front line.

But while these are very much welcome developments, they are nevertheless responses to an outbreak already out of control. After all, military field hospitals would not be needed if adequate health-care services were in place. And, as Uganda has demonstrated after several terrible outbreaks, the key to preventing a major outbreak is a health infrastructure robust enough to be able to respond quickly and effectively when cases first appear.

Medical staff in Uganda now have the training and means to recognize symptoms and isolate patients immediately, and they have access to appropriate equipment and protective clothing. Similarly, social mobilization networks are in place to get information out to the people to reduce the risk of spread, while laboratory facilities can confirm cases swiftly. It is a highly effective setup that was created with considerable help from the U.S. Centers for Disease Control and Prevention, but it relies wholly upon having strong health infrastructure.

In Liberia, a country that never before had an incidence of Ebola, we were utterly ill-equipped and unprepared. What is so tragic is that, until this outbreak, Liberia had made significant progress in building up its public health systems. With help from organizations such as Gavi, the Vaccine Alliance, we have reduced childhood mortality by two-thirds since 1990, thanks largely to expansive immunization programs.

Much of that good work has now been undermined. Having worked its way through the cracks in our fragile health infrastructure, Ebola has effectively brought health care to a halt in Liberia, as people avoid seeking medical attention. There is nowhere to go. So, with the malaria season setting in and routine immunization programs stopped, even when this outbreak is over we must prepare for other diseases to take hold.

Yet, with Ebola having claimed the lives of 96 of our health workers and infected more than 209 others, recovering is going to be hard. This is a huge hit for a country that had barely 50 doctors to care for a population of 4.4 million at the start of this outbreak.

More than ever, we will be reliant upon assistance from partners such as the United States and Britain, and global health organizations such as the World Health Organization, UNICEF and Gavi, to help rebuild our health systems, invest in health facilities, staff and equipment and restore immunization levels. And it’s not just Liberia — any African nation with a fragile health system is potentially vulnerable to this terrible disease. After all, infectious disease knows no borders.

The United Nations has said it is going to take $1 billion to stop this outbreak. Of course, that’s our immediate priority. But at the same time, countries like Liberia need long-term investment to build up our health systems to prevent outbreaks of this scale from ever happening again. We owe it to the thousands of citizens and health workers who have so far lost their lives to be prepared.

Opinion: There is a strong economic case for universal health coverage

Opinion: There is a strong economic case for universal health coverage
Jim Yong Kim, President, World Bank Group
Financial Times, October 17, 2014
[Full text]

Leaders in emerging markets often tell me they want to improve their competitiveness while lifting people out of poverty and protecting a growing middle class from sliding back into it.

In countries including Brazil, China, Thailand and Turkey, universal health coverage has been a key investment. India is the latest to introduce universal health coverage to give its citizens access to essential services.
The economic case for universal health coverage is strong. The recent Lancet Commission on Investing in Health looked at broader measures of growth and found that from 2000 to 2011 health investments were responsible for nearly a quarter of growth in developing countries.

Universal health coverage protects the poor and near-poor from catastrophic economic and social costs related to health expenditures, which impoverish 100m people a year worldwide.

With increasing incomes and the emergence of a sizeable middle class, public expectations for emerging markets’ health systems are rising. Recent surveys in Brazil show that healthcare is a top concern. Meeting such expectations is a daunting task.

Advanced medical technologies are available to emerging markets; their ability to finance them is not. As fast growing health systems put pressure on scarce resources, countries must spend smarter for better outcomes while keeping budgets in check.

Demographics are a big factor. In China, the number of people aged 65 and over is expected nearly to treble from 123m to 330m by 2050, to a quarter of the population. As people age and lifestyles change, the burden of chronic diseases has risen sharply and accounts for 80 per cent of China’s overall disease burden.

Many health systems are ill-prepared. Diabetes is rapidly increasing in Indonesia, yet only half of public primary health centres are equipped to diagnose it. Many countries can’t provide timely access to emergency care for cardiovascular disease or cancer diagnosis and treatment. Our analysis of universal health coverage programmes in 24 countries shows that coverage and implementation are weakest for non-communicable diseases, in spite of the fact that they represent the bulk of the disease burden in emerging markets.

How can these challenges be met?
Emerging markets need to cut admissions to hospitals. In China, admissions nearly doubled between 2003 and 2008. The trend of shifting outpatient treatment to inpatient to maximise reimbursement is costly, inefficient and inequitable.

Reducing the cost and frequency of hospital visits, however, depends on having the right incentives. Evidence from Brazil and elsewhere shows that investments in primary care can reduce hospital admissions. Effective, community-based and patient-centred primary care – co-ordinated with a broader network of social services – can prevent illness, reduce complications and facilitate access to health services across the system.

Recruiting and training more community-based health workers creates jobs, increases economic opportunities in poor and remote communities and enables task-sharing, so doctors and nurses can be deployed more efficiently.

Countries can work with the private sector to cut healthcare costs and expand quality care. I recently visited Aier Eye Group in China, which treats more than 2m people a year for common eye problems, using new technology and operational procedures. India’s Uttarakhand state is piloting a system in its most remote areas with an integrated service delivery network of public and private, community-based and mobile providers supported by telemedicine.

Emerging markets need affordable, smart and sustainable health financing models. Thailand and Turkey have made remarkable strides in using prepayment schemes to reduce out-of-pocket payments and to improve equity. In the Philippines, taxes on alcohol and tobacco have generated significant revenue for financing universal health coverage.

Many of the problems facing emerging markets are similar to those in high-income countries but the solutions are not. Providing effective universal health coverage systems requires countries to develop new models of healthcare delivery and financing to adapt to changing needs.

But the rewards are great. They will increase the health and wellbeing of people and provide a more secure and prosperous economic future.

UNESCO Report: Gender Equality, Heritage and Creativity

UNESCO Report: Gender Equality, Heritage and Creativity
2014 :: 158 pages
ISBN 978-92-3-100050-8
Report pdf:

[From overview]
Women have been particularly marginalized from cultural life. They face many barriers to access, contribute and participate equally in theatre, cinema, arts, music and heritage, which prevents them from developing their full potential and impedes social and inclusive sustainable development.

The UNESCO report on Gender Equality, Heritage and Creativity demonstrates the need to enhance debate, research and awareness-raising regarding equal rights, responsibilities and opportunities for women and men, girls and boys in the areas of heritage and creativity. The report points out symptoms encountered in other areas of socio-economic life: limited participation of women in decision-making positions; discrimination in certain activities; restricted opportunities for continuing education, capacity building and networking; women’s unequal share of unpaid care work, poor conditions of employment (e.g. part-time, contract or informal work) as well as gender stereotypes and fixed ideas about culturally appropriate roles for men and women, not necessarily based on the consent of those involved.

Initiated by the Culture Sector of UNESCO, the report brings together for the first time research, policies, case studies and existing statistics on gender equality and empowerment of women, conducted by the Special Rapporteur of the United Nations in the field of cultural rights, Farida Shaheed, by government officials, research groups, think tanks, academics, artists and heritage professionals. This report includes recommendations in the areas of heritage and creativity for governments, policy makers and the larger international community.

Report Conclusions
This report provides evidence and suggestions for further action on how gender equality and culture can be mutually reinforcing and serve to achieve positive social transformations with benefits for everyone. As a driver and an enabler of sustainable development, culture determines the way in which individuals and communities understand the world, and envisage and shape their future. Building a better future, in particular concerning the post-2015 development framework, requires strategies that ensure that both women and men have equal rights and opportunities to fully and actively participate in all spheres of cultural life.
As such, this report sought to contribute to the growing body of evidence of the importance of culture for inclusive, sustainable and human-rights based development. Adding a gender lens to this evidence is critical at a time when the international community debates the new development architecture that will replace the existing Millennium Development Goals (MDGs), and that gender equality will likely be a stand-alone goal in the post-2015 development framework. This report is a reminder that the human rights normative framework in place, including UNESCO’s culture conventions, offer a strong platform, based on international consensus, for governments, the international community and civil society to work together to ensure that cultural practices are in harmony with human rights, including women’s rights.

This represents the first global stock take and reflection by UNESCO of the rich albeit complex relationship between culture and gender equality through a focus on the two pillars of creativity and heritage. Gender issues permeate all areas of cultural life: as the DNA of communities,

culture provides a unique space where gender roles and social norms are constantly questioned, challenged as well as reinforced and reimagined…

The gender diagnosis of heritage and creativity identifies symptoms that are familiar in other areas of socioeconomic life: limited participation of women in decision-making positions (the “glass ceiling”); segregation into certain activities (‘glass walls’); restricted opportunities for ongoing training, capacity-building and networking; women’s unequal share of unpaid care work; poor employment conditions (part-time, contractual work, informality, etc.) as well as gender stereotypes and fixed ideas about culturally appropriate roles for women and men, not necessarily based on the consent of those concerned. Lack of sex-disaggregated cultural data is a factor concealing the gender gaps and challenges from policy-makers and decision-makers…

To conclude, the report calls for culture and gender equality to be seen as partners for inclusive, sustainable and human rights-based development. It raises the challenge for the international community of ensuring that policies and measures aim to reinforce and strengthen the mutually reinforcing nexus between gender equality and culture. Gender-responsive and transformative approaches can better support international cooperation efforts to safeguard heritage and foster creativity for future generations. This requires recognizing the full potential of women and girls as agents of change and for societies everywhere to support the empowerment of all their citizens as wellsprings for innovative, dynamic and sustainable development…

UNISDR: Development of the Post-2015 Framework for Disaster Risk Reduction

UNISDR: Development of the Post-2015 Framework for Disaster Risk Reduction
UN Office for Disaster Risk Reduction
Zero draft submitted by the Co-Chairs of the Preparatory Committee (20 October 2014)
GENEVA, 21 October 2014 – The Zero Draft of the post-2015 framework for disaster risk reduction is an early draft of the final document which will be adopted at the Third UN World Conference on Disaster Risk Reduction in Sendai, Japan, next March.

[Excerpt from Preamble]
A. Preamble
1. This post-2015 framework for disaster risk reduction was adopted at the Third United Nations World Conference on Disaster Risk Reduction, held from 14 to 18 March 2015 in Sendai, Miyagi, Japan. The World Conference represented a unique opportunity for countries to: i) adopt a concise, focused, forward-looking and action-oriented post-2015 framework for disaster risk reduction and ii) identify modalities of cooperation and the periodic review of its implementation based on the assessment and review of the implementation of the Hyogo Framework for Action (HFA) and the experience gained through the regional and national strategies, institutions and plans for disaster risk reduction, as well as relevant regional and multilateral agreements.

The Hyogo Framework for Action: lessons learned and gaps identified

2. Since the adoption of the HFA in 2005, and as documented in national and regional progress reports on HFA implementation as well as in other global reports, progress has been achieved in reducing disaster risk at local, national, regional and global levels by countries and other stakeholders. This has contributed to decreasing mortality risk in the case of hazards,[1] such as floods and tropical storms. There is growing evidence that reducing disaster risk is a cost effective investment in preventing future losses. Countries have enhanced their capacities. International mechanisms for cooperation, such as the Global Platform for Disaster Risk Reduction and the regional platforms for disaster risk reduction have been instrumental in the development of policies, strategies, the advancement of knowledge and mutual learning. Overall, the HFA has been an important instrument for raising public and institutional awareness, generating political commitment, and focusing and catalyzing actions by a wide range of stakeholders at local, national, regional and global levels.

3. Over the same 10-year time frame, however, disasters have continued to exact a heavy toll. Over 700 thousand people lost their lives, over 1.4 million were injured, and around 23 million were made homeless as a result of disasters. Overall, more than 1.5 billion people were affected by disasters in various ways. The total economic loss was more than $1.3 trillion. In addition, between 2008 and 2012, 144 million were displaced by disasters. Disasters are increasing in frequency and intensity, and those exacerbated by climate change are significantly impeding progress toward sustainable development. Evidence indicates that exposure of people and assets in all countries has increased faster than vulnerability[2] has decreased, thus generating new risk and a steady rise in disasters losses with significant socio-economic impact in the short, medium and long term, especially at the local and community level. Recurring small scale, slow-onset and extensive disasters particularly affect communities, households and small and medium enterprises and constitute a high percentage of all losses. All governments — especially those in developing countries where the mortality and economic losses from disasters are disproportionately higher — and businesses are faced with increasing levels of possible hidden costs and challenges to meet financial and other obligations. The security of people, communities and countries may also be affected.

4. We are at a crossroads. It is urgent and critical to anticipate, plan for and act on risk scenarios over at least the next 50 years to protect more effectively human beings and their assets, and ecosystems.

5. There has to be a broader and a more people-centred preventive approach to disaster risk. Enhanced work to address exposure and vulnerability and ensure accountability for risk creation is required at all levels. More dedicated action needs to be focused on tackling underlying risk drivers and compounding factors, such as demographic change, the consequences of poverty and inequality, weak governance, inadequate and non-risk-informed policies, limited capacity especially at the local level, poorly managed urban and rural development, declining ecosystems, climate change and variability, and conflict situations. Such risk drivers condition the resilience of households, communities, businesses and the public sector. Moreover, it is necessary to continue increasing preparedness for response and reconstruction and use post-disaster reconstruction and recovery to reduce future disaster risk.

6. Disaster risk reduction practices need to be multi-hazard based, inclusive and accessible to be efficient and effective. It is necessary to ensure the engagement of all stakeholders and the participation of women, children and youth, persons with disabilities, indigenous peoples, volunteers, the community of practitioners, and older persons in the design and implementation of policies, plans and standards. There is a need for the public and private sectors to work more closely together and create opportunities for collaboration, and for business to integrate disaster risk into their management practices, investments and accounting….

The Role of Research and Innovation in the Post-2015 Development Agenda Bridging the Divide Between the Richest and the Poorest Within a Generation

The Role of Research and Innovation in the Post-2015 Development Agenda Bridging the Divide Between the Richest and the Poorest Within a Generation
October 2014 :: 16 pages
This paper was written by Claire Wingfield (PATH) in consultation with Kaitlin Christenson from the Global Health Technologies Coalition (GHTC), Carel IJsselmuiden (COHRED), Hester Kuipers from the International AIDS Vaccine Initiative (IAVI), and Maite Suárez (IAVI) with support from John Ballenot (PATH), Jean-Pierre LeGuillou (PATH), Tricia Aung (PATH), and Nick Taylor (GHTC).

Executive Summary
The post-2015 development agenda will provide a framework for identifying global and national priorities and galvanizing action toward poverty reduction and sustainable development for all. Because poor health and disability contribute substantially to poverty, research, and innovation for health is critical to eradicating poverty and should figure prominently in the post-2015 development agenda.

Progress on developing new interventions targeting poverty-related and neglected diseases has faltered because these diseases occur almost exclusively among the world’s poorest and most marginalized populations in low- and middle-income countries (LMICs). Although a clear public health need or gap may exist, this need does not necessarily translate into demand for new and improved health tools. Research and development (R&D) and innovation for health—particularly for the world’s poorest—can help to increase demand by creating new health technologies, expanding coverage of existing tools, and contributing to economic growth.

Gains made toward achieving the Millennium Development Goals (MDGs) related to health (MDGs 4, 5, and 6) have been based largely on R&D investments made years earlier. However, the health technologies that have contributed to this progress are insufficient to overcome existing and emerging health challenges and ultimately to achieve the goals of the post-2015 agenda. Current R&D investments in health are inadequate to meet tomorrow’s challenges. Although there are promising tools in the pipeline—including effective vaccines and preventive technologies against HIV/AIDS, tuberculosis, malaria, and neglected tropical diseases; new and improved drugs to treat resistant strains of these diseases; rapid diagnostics that enable early identification and treatment; and female-controlled family planning technologies that enable women to protect themselves and their partners from unintended pregnancies and sexually transmitted infections—to meet global health challenges, investments in the development and deployment of these tools need to be continued and increased to achieve the expected impact.

This paper is intended to build support for research and innovation in the final post-2015 agenda, as well as to stimulate and inform discussion about how to measure the impact of R&D of new and improved health tools targeting the needs of LMICs. The authors build on the work of the Lancet Commission on Investing in Health, which called for doubling current R&D investments in health from all countries to bridge the divide between the richest and poorest within a generation. To achieve this bold vision, the authors contend that research and innovation for health must be a central component of the post-2015 development agenda.

WHO: Statement on the 3rd meeting of the IHR Emergency Committee regarding the 2014 Ebola outbreak in West Africa

WHO: Statement on the 3rd meeting of the IHR Emergency Committee regarding the 2014 Ebola outbreak in West Africa
WHO statement
23 October 2014
[Full text; Editor’s text bolding]

The third meeting of the Emergency Committee convened by the WHO Director-General under the IHR 2005 regarding the 2014 Ebola virus disease (EVD, or “Ebola”) outbreak in West Africa was conducted with members and advisors of the Emergency Committee on Wednesday, 22 October 2014, from 13:00 to 17:10 CET.

This meeting was convened in advance of the 3-month date of the expiration of the temporary recommendations issued on 8 August 2014 and their extension on 22 September 2014, owing to the increase in numbers of cases in Guinea, Liberia, and Sierra Leone, and the new exportation of cases resulting in limited transmission in Spain and United States of America.

Current situation
The current situation was reviewed. As of 22 October 2014, the number of total cases stands at 9936 total cases, with 4877 deaths. Cases continue to increase exponentially in Guinea, Liberia, and Sierra Leone; the situation in these countries remains of great concern. The key lessons learned to control the outbreak include the importance of leadership, community engagement, bringing in more partners, paying staff on time, and accountability. WHO, UN partners and the international community have scaled up their support in these three countries.

The outbreaks in Nigeria and Senegal were declared over as of 20 October and 17 October, respectively. The Committee welcomed this development and commended those involved in this achievement.

Cases have recently occurred in Spain and United States of America. The index cases in both of these countries originated in West Africa.

Update by IHR States Parties
After the overview summary, the following IHR States Parties provided an update on and assessment of the Ebola situation in their countries, including progress towards implementation of the Emergency Committee’s Temporary Recommendations: Guinea, Liberia, Sierra Leone, Spain, and United States of America.

It was the unanimous view of the Committee that the event continues to constitute a Public Health Emergency of International Concern (PHEIC).

In light of States Parties’ presentations and subsequent Committee discussions, several points and challenges were noted for the affected countries and other countries. The primary emphasis must continue to be stopping the transmission of Ebola within the 3 affected countries with intense transmission. This action is the most important step for preventing international spread. Specific attention, including through appropriate monitoring and follow-up of their health, should be paid to the needs of health care workers.

This will also encourage more health care staff to assist in this outbreak.

The Committee reviewed the recommendations issued on 8 August and the comments published on 22 September, and provided the following additional advice to the Director-General for her consideration in addressing the Ebola outbreak in accordance with IHR (2005). All previous temporary recommendations remain in effect. Even though a few cases have occurred outside the 3 countries with intense transmission, the measures recommended appear to have been helpful in limiting further international spread. Additional recommendations follow below.

Recommendations for States with intense Ebola transmission (Guinea, Liberia, Sierra Leone)
Exit screening in Guinea, Liberia and Sierra Leone remains critical for reducing the exportation of Ebola cases. States should maintain and reinforce high-quality exit screening of all persons at international airports, seaport, and major land crossings, for unexplained febrile illness consistent with potential Ebola infection. The exit screening should consist of, at a minimum, a questionnaire, a temperature measurement and, if fever is discovered, an assessment of the risk that the fever is caused by Ebola virus disease (EVD). States should collect data from their exit screening processes, monitor their results, and share these with WHO on a regular basis and in a timely fashion. This will increase public confidence and provide important information to other States.

WHO and partners should provide additional support needed by States to further strengthen exit screening processes in a sustainable way.

Recommendations for all States
The Committee reiterated its recommendation that there should be no general ban on international travel or trade. A general travel ban is likely to cause economic hardship, and could consequently increase the uncontrolled migration of people from affected countries, raising the risk of international spread of Ebola. The Committee emphasized the importance of normalizing air travel and the movement of ships, including the handling of cargo and goods, to and from the affected areas, to reduce the isolation and economic hardship of the affected countries. Any necessary medical treatment should be available ashore for seafarers and passengers.
Previous recommendations regarding the travel of EVD cases and contacts should continue to be implemented.

A number of States have recently introduced entry screening measures. WHO encourages countries implementing such measures to share their experiences and lessons learned. Entry screening may have a limited effect in reducing international spread when added to exit screening, and its advantages and disadvantages should be carefully considered.

If entry screening is implemented, States should take into account the following considerations: it offers an opportunity for individual sensitization, but the resource demands may be significant, even if screening is targeted; and management systems must be in place to care for travellers and suspected cases in compliance with International Health Regulations (IHR) requirements.

A number of States without Ebola transmission have decided to or are considering cancelling international meetings and mass gatherings. Although the Committee does not recommend such cancellations, it recognizes that these are complex decisions that must be decided on a case-by-case basis. The Committee encourages States to use a risk-based approach to make these decisions. WHO has issued advice for countries hosting international meetings or mass gatherings, and will continue to provide guidance and support on this issue. The Committee agreed that there should not be a general ban on participation of competitors or delegations from countries with transmission of Ebola wishing to attend international events and mass gatherings but that the decision of participation must be made on a case by case basis by the hosting country. The temporary recommendations relating to travel should apply; additional health monitoring may be requested.

All countries should strengthen education and communication efforts to combat stigma, disproportionate fear, and inappropriate measures and reactions associated with Ebola. Such efforts may also encourage self-reporting and early presentation for diagnosis and care.

The Committee emphasized the importance of continued support by WHO and other national and international partners towards the effective implementation and monitoring of these recommendations.

Based on this advice and the information considered by the Committee, the Director-General accepted the Committee’s assessment, and declared that the 2014 Ebola outbreak in Guinea, Liberia and Sierra Leone continued to constitute a Public Health Emergency of International Concern. The Director-General endorsed the Committee’s advice and issued them as Temporary Recommendations under IHR (2005). The Director-General thanked the Committee members and advisors for their advice and requested their reassessment of this situation within 3 months or earlier should circumstances require.