BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 30 May 2015)

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Research article
Making health insurance pro-poor: evidence from a household panel in rural China
Mateusz Filipski, Yumei Zhang, Kevin Chen BMC Health Services Research 2015, 15:210 (29 May 2015)
Abstract
Background
In 2002, China launched the largest public health insurance scheme in the world, the New Cooperative Medical Scheme (NCMS). It is intended to enable rural populations to access health care services, and to curb medical impoverishment. Whether the scheme can reach its equity goals depends on how it is used, and by whom. Our goal is to shed light on whether and how income levels affect the ability of members to reap insurance benefits.
Methods
We exploit primary panel data consisting of a complete census (over 3500 individuals) in three villages in Puding County, Guizhou province, collected in 2004, 2006, 2009 and 2011. Data was collected during in-person interviews with household member(s). The data include yearly gross and net medical expenses for all individuals, and socio-economic information. We apply probit, ordinary least squares, and tobit multivariate regression analyses to the three waves in which NCMS was active (2006, 2009 and 2011). Explained variables include obtainment, levels and rates of NCMS reimbursement. Household income is the main explanatory variable, with household- and individual-level controls. We restrict samples to rule out self-selection, and exploit the 2009 NCMS reform to highlight equity-enhancing features of insurance.
Results
Prior to 2009 reforms, higher income in our sample was statistically significantly related to higher probability of obtaining reimbursement, as well as higher levels and rates of reimbursement. These relations all disappear after the reform, suggesting lower-income households were better able to reap insurance benefits after the scheme was reformed. Regression results suggest this is partly explained by reimbursement for chronic diseases.
Conclusions
The post-reform NCMS distributed benefits more equitably in our study area. Making health insurance pro-poor may require a focus on outpatient costs, credit constraints and chronic diseases, rather than catastrophic illnesses.

BMC Medical Ethics
http://www.biomedcentral.com/bmcmedethics/content
(Accessed 30 May 2015)

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Debate
Research partnerships between high and low-income countries: are international partnerships always a good thing?
John D Chetwood, Nimzing G Ladep, Simon D Taylor-Robinson BMC Medical Ethics 2015, 16:36 (28 May 2015)
Abstract
Background
International partnerships in research are receiving ever greater attention, given that technology has diminished the restriction of geographical barriers with the effects of globalisation becoming more evident, and populations increasingly more mobile.
Discussion
In this article, we examine the merits and risks of such collaboration even when strict universal ethical guidelines are maintained. There has been widespread examples of outcomes beneficial and detrimental for both high and low –income countries which are often initially unintended.
Summary
The authors feel that extreme care and forethought should be exercised by all involved parties, despite the fact that many implications from such international work can be extremely hard to predict. However ultimately the benefits gained by enhancing medical research and philanthropy are too extensive to be ignored

BMC Public Health
http://www.biomedcentral.com/bmcpublichealth/content
(Accessed 30 May 2015)

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Research article
Effects of cash transfers on Children’s health and social protection in Sub-Saharan Africa: differences in outcomes based on orphan status and household assets
Thomas Crea, Andrew Reynolds, Aakanksha Sinha, Jeffrey Eaton, Laura Robertson, Phyllis Mushati, Lovemore Dumba, Gideon Mavise, J. Makoni, Christina Schumacher, Constance Nyamukapa, Simon Gregson BMC Public Health 2015, 15:511 (28 May 2015)
Abstract
Background
Unconditional and conditional cash transfer programmes (UCT and CCT) show potential to improve the well-being of orphans and other children made vulnerable by HIV/AIDS (OVC). We address the gap in current understanding about the extent to which household-based cash transfers differentially impact individual children’s outcomes, according to risk or protective factors such as orphan status and household assets.
Methods
Data were obtained from a cluster-randomised controlled trial in eastern Zimbabwe, with random assignment to three study arms – UCT, CCT or control. The sample included 5,331 children ages 6-17 from 1,697 households. Generalized linear mixed models were specified to predict OVC health vulnerability (child chronic illness and disability) and social protection (birth registration and 90% school attendance). Models included child-level risk factors (age, orphan status); household risk factors (adults with chronic illnesses and disabilities, greater household size); and household protective factors (including asset-holding). Interactions were systematically tested.
Results
Orphan status was associated with decreased likelihood for birth registration, and paternal orphans and children for whom both parents’ survival status was unknown were less likely to attend school. In the UCT arm, paternal orphans fared better in likelihood of birth registration compared with non-paternal orphans. Effects of study arms on outcomes were not moderated by any other risk or protective factors. High household asset-holding was associated with decreased likelihood of child’s chronic illness and increased birth registration and school attendance, but household assets did not moderate the effects of cash transfers on risk or protective factors.
Conclusion
Orphaned children are at higher risk for poor social protection outcomes even when cared for in family-based settings. UCT and CCT each produced direct effects on children’s social protection which are not moderated by other child- and household-level risk factors, but orphans are less likely to attend school or obtain birth registration. The effects of UCT and CCT are not moderated by asset-holding, but greater household assets predict greater social protection outcomes. Intervention efforts need to focus on ameliorating the additional risk burden carried by orphaned children. These efforts might include caregiver education, and additional incentives based on efforts made specifically for orphaned children.

Disability and Rehabilitation: Assistive Technology
Volume 10, Number 4 (July 2015)
http://informahealthcare.com/toc/idt/current

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Special Section: Assistive Technology Access to Assistive Technology in Resource Limited Environments
Guest Editors – Mark Harniss and Deepti Samant Raja
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Editorial
Assistive technology access and service delivery in resource-limited environments: introduction to a special issue of Disability and Rehabilitation: Assistive Technology
July 2015, Vol. 10, No. 4 , Pages 267-270 (doi:10.3109/17483107.2015.1039607)
Mark Harniss, Deepti Samant Raja, and Rebecca Matter
1Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA, 2Burton Blatt Institute, Syracuse University, Washington, DC, USA, 3Center for Technology and Disability Studies, University of Washington, Seattle, WA, USA, and 4School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
Abstract
This special issue addresses access to and service delivery of assistive technology (AT) in resource-limited environments (RLEs). Access to AT is complicated not simply by limited funds to purchase AT, but by larger ecosystem weaknesses in RLEs related to legislation and policy, supply, distribution, human resources, consumer demand and accessible design. We present eight diverse articles that address various aspects of the AT ecosystem. These articles represent a wide range of AT, many different countries and different research methods. Our goal is to highlight a topic that has received scant research investigation and limited investment in international development efforts, and offer an insight into how different countries and programs are promoting access to AT. We encourage researchers, funders and non-profit organizations to invest additional effort and resources in this area.
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Users’ perspectives on the provision of assistive technologies in Bangladesh: awareness, providers, costs and barriers
Johan Borg, Per-Olof Östergren
Disability and Rehabilitation: Assistive Technology Jul 2015, Vol. 10, No. 4: 301–308.
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Comparison between performances of three types of manual wheelchairs often distributed in low-resource settings
Karen Rispin, Joy Wee
Disability and Rehabilitation: Assistive Technology Jul 2015, Vol. 10, No. 4: 316–322.
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The use of mobile devices as assistive technology in resource-limited environments: access for learners with visual impairments in Kenya
Alan R. Foley, Joanna O. Masingila
Disability and Rehabilitation: Assistive Technology Jul 2015, Vol. 10, No. 4: 332–339.
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Using SMS as a tool to reduce exclusions experienced by caregivers of people with disabilities in a resource-limited Colombian community
Tim Barlott, Kim Adams, Francene Rodríguez Díaz, Mónica Mendoza Molina
Disability and Rehabilitation: Assistive Technology Jul 2015, Vol. 10, No. 4: 347–354.

Food Security
Volume 7, Issue 3, June 2015
http://link.springer.com/journal/12571/7/2/page/1

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Special Theme: Strengthening the links between nutrition and health outcomes and agricultural research
This special section has three groups of papers. The first three set the stage by laying out the context of the enabling socio-political environment, and desired outcomes of the food system: improving multiple aspects of nutrition simultaneously, and sustainably within environmental boundaries The second set of papers deals with increasing access to nutritious, safe food through markets, as well as non-market channels. The last two papers synthesize what this current research means for agricultural research and policy.

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 30 May 2015]

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Research
Tracking Global Fund HIV/AIDS resources used for sexual and reproductive health service integration: case study from Ethiopia
Mookherji S, Ski S and Huntington D Globalization and Health 2015, 11:21 (27 May 2015)
Abstract (provisional)
Objective/Background
The Global Fund to Fight AIDS, Tuberculosis & Malaria (GF) strives for high value for money, encouraging countries to integrate synergistic services and systems strengthening to maximize investments. The GF needs to show how, and how much, its grants support more than just HIV/AIDS, TB and malaria. Sexual and Reproductive Health (SRH) has been part of HIV/AIDS grants since 2007. Previous studies showed the GF PBF system does not allow resource tracking for SRH integration within HIV/AIDS grants. We present findings from a resource tracking case study using primary data collected at country level.
Methods
Ethiopia was the study site. We reviewed data from four HIV/AIDS grants from January 2009-June 2011 and categorized SDAs and activities as directly, indirectly, or not related to SRH integration. Data included: GF PBF data; financial, performance, in-depth interview and facility observation data from Ethiopia.
Results
All HIV/AIDS grants in Ethiopia support SRH integration activities (12-100%). Using activities within SDAs, expenditures directly supporting SRH integration increased from 25% to 66% for the largest HIV/AIDS grant, and from 21% to 34% for the smaller PMTCT-focused grant. Using SDAs to categorize expenditures underestimated direct investments in SRH integration; activity-based categorization is more accurate. The important finding is that primary data collection could not resolve the limitations in using GF GPR data for resource tracking. The remedy is to require existing activity-based budgets and expenditure reports as part of PBF reporting requirements, and make them available in the grant portfolio database. The GF should do this quickly, as it is a serious shortfall in the GF guiding principle of transparency.
Conclusions
Showing high value for money is important for maximizing impact and replenishments. The Global Fund should routinely track HIV/AIDs grant expenditures to disease control, service integration, and overall health systems strengthening. The current PBF system will not allow this. Real-time expenditure analysis could be achieved by integrating existing activity-based financial data into the routine PBF system. The GF’s New Funding Model and the 2012-2016 strategy present good opportunities for over-hauling the PBF system to improve transparency and allow the GF to monitor and maximize value for money.

Health Economics, Policy and Law
Volume 10 – Issue 03 – July 2015
http://journals.cambridge.org/action/displayIssue?jid=HEP&tab=currentissue

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The impact of Universal Health Coverage on health care consumption and risky behaviours: evidence from Thailand
Simone Ghislandi, Wanwiphang Manachotphong and Viviana M.E. Perego
Health Economics, Policy and Law / Volume 10 / Issue 03 / July 2015, pp 251 – 266
Abstract
Thailand is among the first non-OECD countries to have introduced a form of Universal Health Coverage (UHC). This policy represents a natural experiment to evaluate the effects of public health insurance on health behaviours. In this paper, we examine the impact of Thailand’s UHC programme on preventive activities, unhealthy or risky behaviours and health care consumption using data from the Thai Health and Welfare Survey. We use doubly robust estimators that combine propensity scores and linear regressions to estimate differences-in-differences (DD) and differences-in-DD models. Our results offer important insights. First, UHC increases individuals’ likelihood of having an annual check-up, especially among women. Regarding health care consumption, we observe that UHC increases hospital admissions by over 2% and increases outpatient visits by 13%. However, there is no evidence that UHC leads to an increase in unhealthy behaviours or a reduction of preventive efforts. In other words, we find no evidence of ex ante moral hazard. Overall, these findings suggest positive health impacts among the Thai population covered by UHC.

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 30 May 2015]
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Research
The role of policy actors and contextual factors in policy agenda setting and formulation: maternal fee exemption policies in Ghana over four and a half decades
Augustina Koduah, Han van Dijk, Irene Agyepong Health Research Policy and Systems 2015, 13:27 (30 May 2015)
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Research
Utilization of research findings for health policy making and practice: evidence from three case studies in Bangladesh
David Walugembe, Suzanne Kiwanuka, Joseph Matovu, Elizeus Rutebemberwa, Laura Reichenbach Health Research Policy and Systems 2015, 13:26 (28 May 2015)

The Lancet
May 30, 2015 Volume 385 Number 9983 p2121-2222
http://www.thelancet.com/journals/lancet/issue/current

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Comment
African health leaders: claiming the future
Agnes Binagwaho, Nigel Crisp
DOI: http://dx.doi.org/10.1016/S0140-6736(15)60934-5
Improving health in Africa is a team effort that involves many people from different backgrounds. The health gains made in recent years would not have been possible without the contribution of these people, national and global political will, and the support of development partners. All too often, however, the part played by Africans themselves has been overlooked or downplayed internationally in policy making and publications.

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Comment
Offline: An irreversible change in global health governance
Richard Horton
DOI: http://dx.doi.org/10.1016/S0140-6736(15)60997-7
“We should have reacted sooner”, was Angela Merkel’s conclusion in her address to the World Health Assembly last week. She was speaking about Ebola, and she gave a sharp and public rebuke to WHO for its diffident performance. WHO’s decentralised structure can be a powerful advantage, she said, but it “can also impede decision-making and hinder good functioning”. Still, despite its weaknesses, “WHO is the only international organisation that enjoys universal political legitimacy on global health matters.” It should be supported. Her assessment was backed by the Ebola Interim Assessment Panel, chaired by Barbara Stocking and whose first report was debated by WHO’s member states the next day. Stocking and her team, which included, among others, Ilona Kickbusch and Julio Frenk, listed their concerns with compelling clarity. They expressed surprise that it took WHO so long to recognise what it would take to bring Ebola transmission under control. Why did repeated early warnings from May to July, 2014, fail to trigger the declaration of a Public Health Emergency of International Concern before Aug 8, 2014, the date when an emergency was finally announced? Why was WHO unable “to engage in a high-level media response with greater command over the narrative”? Why did WHO fail to seek appropriate support from other UN agencies and humanitarian organisations? Why did WHO fail to ensure it had the operational capacity and culture to manage a public health emergency response? Donors were not spared: WHO “suffers from a lack of political and financial commitment by its Member States”. The Panel commented that “this [is] a defining moment for the work of WHO…’Business as usual’ or ‘more of the same’ is not an option.” Stocking concluded that, “Now is the historic political moment for world leaders to give WHO new relevance and empower it to lead in global health.”

Understandably, the Panel preferred to place responsibility on structures, not individuals. This is entirely correct. But structures are made up of individuals, and it is individuals who make decisions. There needs to be some serious soul-searching within the agency about who did what, when, and why it went wrong. The Lancet has felt resistance to these questions, in sometimes acutely hostile terms from WHO staff members. If WHO diagnoses the international response to Ebola as a collective failure and not as a failure of its own processes, procedures, and people, it risks sustaining the conditions that have led to this public health catastrophe for millions of west Africans. For example, it is surreal for WHO to say, as it did last week, that it has now heard what the world expects from the agency. Does this statement mean it was only when Ebola swept across west Africa that WHO woke up to an understanding of its global role? When WHO says that it will strengthen its command and control systems, does this statement mean that after six decades of experience in responding to health crises it needed Ebola to make the agency realise the importance of leadership? And can anyone take the statement that Ebola has accelerated reforms to the organisation seriously when the recent “WHO reform” programme is widely judged (internally and externally) to have delivered few tangible benefits to the agency’s work?

Debates about Ebola and WHO’s response (and future) certainly overwhelmed discussions in Geneva last week. But the most exciting moment was not in the Assembly Hall or Committees. Instead, it was in a small room in the Palais des Nations, and after hours too. For the first time in the history of WHO and its Assembly, a civil-society led forum was held to strengthen political accountability for global health—specifically, for women’s and children’s health. The White Ribbon Alliance, together with the Governments of Bangladesh and Sweden, convened the first Global Dialogue between Citizens and Governments. It was an historic moment. It built on National Citizen’s Hearings held in over 20 countries. Examples from Indonesia and Tanzania were presented with informed passion. Indonesian and Namibian Ministers of Health spoke. This Global Dialogue signalled the beginning of a very different World Health Assembly. What took place last week was an irreversible change in the governance of global health—one in which civil society assumed a legitimate place in shaping the future of health. While WHO reflected (sometimes painfully) on its role and purpose, civil society found its voice. Mark this moment.

The Lancet Global Health
Jun 2015 Volume 3 Number 6 e297-e340
http://www.thelancet.com/journals/langlo/issue/current

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Comment
Global access to surgical care: moving forward
Evan G Wong, Dan L Deckelbaum, Tarek Razek
Open Access
DOI: http://dx.doi.org/10.1016/S2214-109X(15)00004-2
Summary
Global surgical care is gaining ground on the public health platform. Throughout 2015–16, the World Bank is publishing the long-anticipated third edition of its Disease Control Priorities (DCP3). First published in 1993,1 these reports aim to systematically identify effective interventions to address the disease burden in low-income and middle-income countries. For the first time since its inception, the DCP now includes a distinct volume on the value of surgical care. Volume 1—Essential Surgery2—focuses on the benefits of surgical care, including its potential to substantially decrease mortality while being exceptionally cost-effective; the issues of access to life-saving surgery, perioperative safety, and the inclusion of surgery in universal health coverage are also specifically addressed.

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Comment
Health and sustainable development: a call for papers
Richard Horton, Zoë Mullan
Published Online: 30 April 2015
Open Access
DOI: http://dx.doi.org/10.1016/S2214-109X(15)00002-9
Summary
In just under 5 months’ time, the aspiration for the next 15 years of development efforts will be signed off at the UN General Assembly in New York, USA. These Sustainable Development Goals (SDGs) are already at an advanced stage of drafting—17 ambitious goals and 169 targets (panel), which have been criticised even by the UN General Secretary for being too voluminous.1 Amid this multitude of outcomes, those pertaining to health are reduced from three Millennium Development Goals to one SDG. What does this mean for global health research?

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Articles
Global access to surgical care: a modelling study
Blake C Alkire, MD*, Dr Nakul P Raykar, MD*, Mark G Shrime, MD, Thomas G Weiser, MD, Prof Stephen W Bickler, MD, John A Rose, MD, Cameron T Nutt, BA, Sarah L M Greenberg, MD, Meera Kotagal, MD, Johanna N Riesel, MD, Micaela Esquivel, MD, Tarsicio Uribe-Leitz, MD, George Molina, MD, Prof Nobhojit Roy, MD, John G Meara, MD, Prof Paul E Farmer, MD, *
Published Online: 26 April 2015
Open Access
DOI: http://dx.doi.org/10.1016/S2214-109X(15)70115-4
Summary
Background
More than 2 billion people are unable to receive surgical care based on operating theatre density alone. The vision of the Lancet Commission on Global Surgery is universal access to safe, affordable surgical and anaesthesia care when needed. We aimed to estimate the number of individuals worldwide without access to surgical services as defined by the Commission’s vision.
Methods
We modelled access to surgical services in 196 countries with respect to four dimensions: timeliness, surgical capacity, safety, and affordability. We built a chance tree for each country to model the probability of surgical access with respect to each dimension, and from this we constructed a statistical model to estimate the proportion of the population in each country that does not have access to surgical services. We accounted for uncertainty with one-way sensitivity analyses, multiple imputation for missing data, and probabilistic sensitivity analysis.
Findings
At least 4·8 billion people (95% posterior credible interval 4·6–5·0 [67%, 64–70]) of the world’s population do not have access to surgery. The proportion of the population without access varied widely when stratified by epidemiological region: greater than 95% of the population in south Asia and central, eastern, and western sub-Saharan Africa do not have access to care, whereas less than 5% of the population in Australasia, high-income North America, and western Europe lack access.
Interpretation
Most of the world’s population does not have access to surgical care, and access is inequitably distributed. The near absence of access in many low-income and middle-income countries represents a crisis, and as the global health community continues to support the advancement of universal health coverage, increasing access to surgical services will play a central role in ensuring health care for all.
Funding
None.

PLOS Currents: Disasters
[Accessed 30 May 2015]
http://currents.plos.org/disasters/

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Political Leadership in the Time of Crises: Primum non Nocere
May 29, 2015 · Perspective
Long before the 2014 Ebola outbreak in West Africa, the United States was already experiencing a failure of confidence between politicians and scientists, primarily focused on differences of opinion on climate extremes. This ongoing clash has culminated in an environment where politicians most often no longer listen to scientists. Importation of Ebola virus to the United States prompted an immediate political fervor over travel bans, sealing off borders and disputes over the reliability of both quarantine and treatment protocol. This demonstrated that evidenced- based scientific discourse risks taking a back seat to political hyperbole and fear. The role of public health and medical expertise should be to ensure that cogent response strategies, based upon good science and accumulated knowledge and experience, are put in place to help inform the development of sound public policy. But in times of crisis, such reasoned expertise and experience are too often overlooked in favor of the partisan press “sound bite”, where fear and insecurity have proved to be severely counterproductive. While scientists recognize that science cannot be entirely apolitical, the lessons from the impact of Ebola on political discourse shows that there is need for stronger engagement of the scientific community in crafting messages required for response to such events. This includes the creation of moral and ethical standards for the press, politicians and scientists, a partnership of confidence between the three that does not now exist and an “elected officials” toolbox that helps to translate scientific evidence and experience into readily acceptable policy and public communication.

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
(Accessed 30 May 2015)

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Surveillance of Acute Respiratory Infections Using Community-Submitted Symptoms and Specimens for Molecular Diagnostic Testing
May 27, 2015 · Research
Participatory systems for surveillance of acute respiratory infection give real-time information about infections circulating in the community, yet to-date are limited to self-reported syndromic information only and lacking methods of linking symptom reports to infection types. We developed the GoViral platform to evaluate whether a cohort of lay volunteers could, and would find it useful to, contribute self-reported symptoms online and to compare specimen types for self-collected diagnostic information of sufficient quality for respiratory infection surveillance. Volunteers were recruited, given a kit (collection materials and customized instructions), instructed to report their symptoms weekly, and when sick with cold or flu-like symptoms, requested to collect specimens (saliva and nasal swab). We compared specimen types for respiratory virus detection sensitivity (via polymerase-chain-reaction) and ease of collection. Participants were surveyed to determine receptivity to participating when sick, to receiving information on the type of pathogen causing their infection and types circulating near them. Between December 1 2013 and March 1 2014, 295 participants enrolled in the study and received a kit. Of those who reported symptoms, half (71) collected and sent specimens for analysis. Participants submitted kits on average 2.30 days (95 CI: 1.65 to 2.96) after symptoms began. We found good concordance between nasal and saliva specimens for multiple pathogens, with few discrepancies. Individuals report that saliva collection is easiest and report that receiving information about what pathogen they, and those near them, have is valued and can shape public health behaviors. Community-submitted specimens can be used for the detection of acute respiratory infection with individuals showing receptivity for participating and interest in a real-time picture of respiratory pathogens near them.

PLoS Medicine
(Accessed 30 May 2015)
http://www.plosmedicine.org/

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Seasonal Influenza Vaccination for Children in Thailand: A Cost-Effectiveness Analysis
Aronrag Meeyai, Naiyana Praditsitthikorn, Surachai Kotirum, Wantanee Kulpeng, Weerasak Putthasri, Ben S. Cooper, Yot Teerawattananon
Research Article | published 26 May 2015 | PLOS Medicine 10.1371/journal.pmed.1001829
Abstract
Background
Seasonal influenza is a major cause of mortality worldwide. Routine immunization of children has the potential to reduce this mortality through both direct and indirect protection, but has not been adopted by any low- or middle-income countries. We developed a framework to evaluate the cost-effectiveness of influenza vaccination policies in developing countries and used it to consider annual vaccination of school- and preschool-aged children with either trivalent inactivated influenza vaccine (TIV) or trivalent live-attenuated influenza vaccine (LAIV) in Thailand. We also compared these approaches with a policy of expanding TIV coverage in the elderly.
Methods and Findings
We developed an age-structured model to evaluate the cost-effectiveness of eight vaccination policies parameterized using country-level data from Thailand. For policies using LAIV, we considered five different age groups of children to vaccinate. We adopted a Bayesian evidence-synthesis framework, expressing uncertainty in parameters through probability distributions derived by fitting the model to prospectively collected laboratory-confirmed influenza data from 2005-2009, by meta-analysis of clinical trial data, and by using prior probability distributions derived from literature review and elicitation of expert opinion. We performed sensitivity analyses using alternative assumptions about prior immunity, contact patterns between age groups, the proportion of infections that are symptomatic, cost per unit vaccine, and vaccine effectiveness. Vaccination of children with LAIV was found to be highly cost-effective, with incremental cost-effectiveness ratios between about 2,000 and 5,000 international dollars per disability-adjusted life year averted, and was consistently preferred to TIV-based policies. These findings were robust to extensive sensitivity analyses. The optimal age group to vaccinate with LAIV, however, was sensitive both to the willingness to pay for health benefits and to assumptions about contact patterns between age groups.
Conclusions
Vaccinating school-aged children with LAIV is likely to be cost-effective in Thailand in the short term, though the long-term consequences of such a policy cannot be reliably predicted given current knowledge of influenza epidemiology and immunology. Our work provides a coherent framework that can be used for similar analyses in other low- and middle-income countries.

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 30 May 2015)

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Harnessing Case Isolation and Ring Vaccination to Control Ebola
Chad Wells, Dan Yamin, Martial L. Ndeffo-Mbah, Natasha Wenzel, Stephen G. Gaffney, Jeffrey P. Townsend, Lauren Ancel Meyers, Mosoka Fallah, Tolbert G. Nyenswah, Frederick L. Altice, Katherine E. Atkins, Alison P. Galvani
Research Article | published 29 May 2015 | PLOS Neglected Tropical Diseases 10.1371/journal.pntd.0003794
Abstract
As a devastating Ebola outbreak in West Africa continues, non-pharmaceutical control measures including contact tracing, quarantine, and case isolation are being implemented. In addition, public health agencies are scaling up efforts to test and deploy candidate vaccines. Given the experimental nature and limited initial supplies of vaccines, a mass vaccination campaign might not be feasible. However, ring vaccination of likely case contacts could provide an effective alternative in distributing the vaccine. To evaluate ring vaccination as a strategy for eliminating Ebola, we developed a pair approximation model of Ebola transmission, parameterized by confirmed incidence data from June 2014 to January 2015 in Liberia and Sierra Leone. Our results suggest that if a combined intervention of case isolation and ring vaccination had been initiated in the early fall of 2014, up to an additional 126 cases in Liberia and 560 cases in Sierra Leone could have been averted beyond case isolation alone. The marginal benefit of ring vaccination is predicted to be greatest in settings where there are more contacts per individual, greater clustering among individuals, when contact tracing has low efficacy or vaccination confers post-exposure protection. In such settings, ring vaccination can avert up to an additional 8% of Ebola cases. Accordingly, ring vaccination is predicted to offer a moderately beneficial supplement to ongoing non-pharmaceutical Ebola control efforts.

Author Summary
Public health efforts for controlling the 2014–2015 Ebola outbreak in West Africa have focused on contact tracing and isolation of symptomatic individuals. In addition, substantial resources have been committed to scaling up the production of experimental vaccines. Ring vaccination—the vaccination of the contacts of an infected individual—was successfully implemented to achieve smallpox eradication. Ring vaccination is particularly feasible and effective in settings where the supply of vaccines is limited and disease incidence is low. Using a disease transmission model, we evaluated the benefit of adding ring vaccination to case isolation in Liberia and Sierra Leone. We found that ring vaccination could have averted up to 126 cases in Liberia and 560 cases in Sierra Leone, thereby saving lives and intervention resources.

Refugee Survey Quarterly
Volume 34 Issue 2 June 2015
http://rsq.oxfordjournals.org/content/current
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Articles
“Rather Than Talking in Tamil, They Should Be Talking to Tamils”: Sri Lankan Tamil Refugee Readiness for Repatriation
Miriam George, Wendy Kliewer, and Sebastan Irudaya Rajan
Refugee Survey Quarterly (2015) 34 (2): 1-22 doi:10.1093/rsq/hdv004
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From Ad Hoc to Universal: The International Refugee Regime from Fragmentation to Unity 1922–1954
Gilad Ben-Nun
Refugee Survey Quarterly (2015) 34 (2): 23-44 doi:10.1093/rsq/hdv005
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Refugees’ Conceptualizations of “Protection Space”: Geographical Scales of Urban Protection and Host–Refugee Relations
Eveliina Lyytinen
Refugee Survey Quarterly (2015) 34 (2): 45-77 doi:10.1093/rsq/hdv001
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Getting Refugees to Work: A Street-level Perspective of Refugee Resettlement Policy
Jessica H. Darrow
Refugee Survey Quarterly (2015) 34 (2): 78-106 doi:10.1093/rsq/hdv002

Science
29 May 2015 vol 348, issue 6238, pages 941-1052
http://www.sciencemag.org/current.dtl

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Feature
Is measles next?
Leslie Roberts
Before the polio virus is even in the grave, a small cadre of disease fighters is itching to set the next global eradication target: measles. The case is compelling. Measles killed 145,000 children last year in poor countries and left many more blind, deaf, or disabled. A cheap and effective vaccine has long been on the shelves; numerous expert panels have deemed measles eradication feasible, although daunting—it is the most contagious virus on Earth. But the biggest obstacle to measles eradication is polio, which hasn’t disappeared as it was supposed to do in 2000. Skeptics question whether a measles initiative would fall down the same rabbit hole as did the polio effort, which has spent billions of dollars and nearly 3 decades chasing the last few cases, only to see them disappear around the corner. Maybe it is time, they say, to settle for keeping measles cases really low but not trying to get to zero…

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Feature
In Vietnam, an anatomy of a measles outbreak
Leslie Roberts
Routine immunization is one of the great public health success stories in Vietnam, where rates of vaccine-preventable diseases have plummeted. But the measles outbreak last year was another story, with 60,000 reported cases and nearly 150 deaths in children under age 2. Experts trace the epidemic to the public’s loss of faith in the government-led vaccination program, following reports of adverse events associated in time with another vaccine. Many parents stopped vaccinating their children, leaving them susceptible to measles. When the virus swept in from the north and hit Hanoi, it exploded. Panicked parents rushed their children to the hospital, which was quickly overburdened. With poor infection control, the hospital became a hub of measles transmission, and children who weren’t already infected caught the virus there.

The Sentinel

Human Rights Action :: Humanitarian Response :: Health ::
Holistic Development :: Sustainable Resilience
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Week ending 23 May 2015

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, consortia 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
david.r.curry@ge2p2center.net

pdf verion: The Sentinel_ week ending 23 May 2015

blog edition: comprised of the 35+ entries to be posted below on 24-25 May 2015

Migration  [to 23 May 2015]

UNHCR Statement on Southeast Asia Sea Movements
Press Releases, 20 May 2015
UNHCR welcomes the commitment announced today by the Foreign Ministers of Malaysia, Indonesia and Thailand to resolve the issue of the thousands of refugees and migrants stranded in boats in the Bay of Bengal and off the coast of Southeast Asia. This is an important initial step in the search for solutions to this issue, and vital for the purpose of saving lives.

It is now urgent for people to be brought ashore without delay, and that immediate first aid and other care is provided for all who are in need. We look forward to seeing this happen without delay.

UNHCR agrees with the Ministers that further action will be needed. This includes addressing root causes. It will need to take into account looking properly at the needs of those in need of international protection. As with other regions of the world where we are seeing large movements of people by sea, countries in the region will need to work together for this to be addressed meaningfully and successfully.

UNHCR itself is ready to work with countries in the region to find solutions to the plight of these people. These ultimately may include returning people to their home countries voluntarily and once conditions allow.

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Joint Statement on Andaman Sea: IOM, UNHCR, OHCHR, UN SRSG Migration & Development
Search and rescue at sea, disembarkation, and protection of the human rights of refugees and migrants now imperative to save lives in the Bay of Bengal and Andaman Sea
05/19/15

We strongly urge the leaders of Indonesia, Malaysia, and Thailand to protect migrants and refugees stranded on vessels in the Bay of Bengal and the Andaman Sea, to facilitate safe disembarkation, and to give priority to saving lives, protecting rights, and respecting human dignity.

Grave events in the Bay of Bengal and Andaman Sea in recent days involving migrants and refugees – Rohingya and others – from Bangladesh and Myanmar confirm that vulnerable people around the world are moving in search of safety and dignity, fleeing persecution, abject poverty, deprivation, discrimination, and abuse. Such perilous journeys, whether by land, sea, or air, have become a global phenomenon.

In Southeast Asia, more than 88,000 people have made the dangerous voyage by sea since 2014, including 25,000 who arrived in the first quarter of this year alone. Nearly 1,000 are believed to have perished at sea due to the precarious conditions of the voyage, and an equal number because of mistreatment and privation at the hands of traffickers and abusive smugglers. In the Bay of Bengal, migrants and refugees are fed only white rice and are subjected to violence, including sexual violence. Women are raped. Children are separated from their families and abused. Men are beaten and thrown overboard.

We are deeply concerned at reports that boats full of vulnerable women, men and children are unable to land and are stranded at sea without access to urgently needed food, water, and medical assistance. We urge States in the region to protect the lives of all aboard by allowing the passengers on these overcrowded boats to disembark safely.

We urgently call on leaders, with the support of ASEAN, to:
:: Make saving lives the top priority by inter alia significantly strengthening Search and Rescue (SAR) Operations.
:: Stop boat push-backs and measures to ‘help on’ boats to leave territorial waters, while ensuring that all measures taken are in strict accordance with the principle of non-refoulement and other fundamental human rights standards.
:: Provide for effective, predictable disembarkation to a place of safety with adequate and humane reception conditions.
:: Avoid the use of immigration detention and other punitive measures, and ensure that the human rights of all migrants and refugees are protected, and that all actions in regard to children are guided by the best interests of the child.
:: Set in place screening procedures staffed jointly by government and relevant international organization personnel to identify the individual circumstances of all those arriving, including a) individuals in need of protection as refugees, asylum-seekers, or stateless persons, b) victims of trafficking or persons at risk of torture or other cruel, inhumane, or degrading treatment if returned to their country of origin, c) migrants with health conditions in need of emergency medical care and first aid assistance, and d) migrants or others interested in voluntary return home.
:: Expand avenues for safe and legal migration, including for labour migration at all skills levels.
Expand efforts to prosecute traffickers and smugglers for their crimes in full accordance with international standards for human rights, while fully respecting the rights of victims.
:: Redouble efforts, nationally and through strengthened international cooperation, to address ‘push factors’ and the root causes of refugee and migrants flows, including discrimination, deprivation, persecution, and violations of human rights.
:: Put in place dedicated measures to combat xenophobia and discrimination against any group on the basis of race, sex, language, religion, ethnicity, nationality and national origin, or other status.
António Guterres, UN High Commissioner for Refugees; Zeid Ra’ad Al Hussein, UN High Commissioner for Human Rights; William L. Swing, Director-General of the International Organization for Migration; and Peter Sutherland, Special Representative of the UN Secretary-General for International Migration and Development.

Gaza Economy on the Verge of Collapse, Youth Unemployment Highest in the Region at 60 Percent
JERUSALEM, May 21, 2015 – Blockades, war and poor governance have strangled Gaza’s economy and the unemployment rate is now the highest in the world according to the latest World Bank economic update. The report will be presented to the Ad Hoc Liaison Committee (AHLC), a forum of donors to the Palestinian Authority, at the bi-annual meeting in Brussels on May 27, 2015.The report estimates that Gaza’s GDP would have been about four times higher than it currently is if it weren’t for the conflicts and the multiple restrictions. It also states that the blockade in place since 2007 has shaved around 50 percent off Gaza’s GDP. Unemployment in Gaza is the highest in the world at 43 percent. Even more alarming is the situation of youth unemployment which soared to more than 60 percent by the end of 2014…
Date: May 21, 2015

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Economic monitoring report to the ad hoc liaison committee
Working Paper – 96601 (English)
2015/05/27
Official PDF, 40 pages 1.66 mb
Abstract
This report covers two distinct subjects. Chapter I of the report, as has been the norm with the World Bank Ad Hoc Liaison Committee report, focuses on the assessment of recent macroeconomic and fiscal developments and government policies in West Bank and Gaza. Chapter II presents an analysis of Gaza’s stark economic decline over the past 20 years and its human impact. It also presents a mix of policies that should ensure sustainable development of the Gaza strip and put an end to human suffering therein. The report also contains an annex which provides an overview of progress in meeting the pledges made for Gaza’s reconstruction at the October 2014 Cairo Conference. Although the connection between the chapters of this report may not be obvious as they treat a diverse set of issues facing the Palestinian economy and public finances, together they provide insights into key policy and institutional development actions and reforms, which need to be taken by the Palestinian Authority, the Government of Israel, and the donor community to reverse the recent and worrisome slowdown in economic growth, to enable effective and efficient management of public finances in order to avoid a dangerous fiscal crisis and to support inclusive economic growth and poverty reduction.

Statement by UNODC Executive Director Yury Fedotov: The killing of women and girls shames every society
Vienna, 19 May 2015 – United Nations Office on Drugs and Crime
The following is a statement by Yury Fedotov, UNODC Executive Director:

Women and girls continue to be killed in large numbers around the world. Based on estimates from UNODC at least 43,000 women were murdered by their intimate partners or family members in 2012.

These murders, however, are only the most visible and brutal sign of what is happening to millions of women. Hidden from our view are the dreadful daily experiences of violence, including terrible sexual violence, that blights the lives of women and girls. Such experiences occur in the countryside and in cities alike; as well as in schools, work places and especially the home.

We must also acknowledge that, just as no society is immune from these violent acts, we are all part of the solution. No woman or young girl must be allowed to feel isolated or in danger. This means promoting inclusive societies that not only provide women with much needed security, but also offers them opportunity, equality and prosperity.

UNODC is working to unravel the gender bias that has been woven into many legislations and criminal justice systems and which perpetuates impunity for these violent acts. Our work encourages all those in the criminal justice system to respect and protect women and girls and to view domestic violence as a serious crime.

Violence against women and girls, in all its many forms, shames us all. To end this serious crime, we must all work in a spirit of partnership and cooperation to change laws, change perceptions and change behaviours. If not, we will continue to see this violent crime undermine our efforts to build better, more inclusive societies.