British Medical Journal
09 May 2015  (vol 350, issue 8007)
http://www.bmj.com/content/350/8007

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Editor’s Choice
Towards a better epidemic
BMJ 2015; 350 doi: http://dx.doi.org/10.1136/bmj.h2419 (Published 07 May 2015) Cite this as: BMJ 2015;350:h2419
Tony Delamothe, deputy editor, The BMJ
The consensus seems to be that no one had a particularly good Ebola epidemic, with the exception of the charity Médecins Sans Frontières (MSF). This begs the question of who makes these judgment calls, and what was the last “good” epidemic you can remember?
The World Health Organization got it in the neck for delivering too little, too late, and its own report last week joined in the criticisms, listing lessons learnt and actions planned (doi:10.1136/bmj.h2144). MSF thought the problems went wider than WHO. The international response had been a “global coalition of inaction,” its report concluded (doi:10.1136/bmj.h1619). “For the Ebola outbreak to spiral this far out of control required many institutions to fail,” said its director. MSF also noted that the affected countries hadn’t always made the right choices—not easy for some of the poorest countries on earth.
In The BMJ Christian Gericke continues the generally critical line, saying that the epidemic attracted medical ethics commentators “like bees to a honey pot” (doi:10.1136/bmj.h2105). Were they of any use? He thinks that the short term use of experimental drugs (and their complex ethical challenges) attracted far more attention than it deserved and distracted from the urgent business of controlling the epidemic. He quotes approvingly the bioethicist Udo Schüklenk’s criticism of WHO’s recommendation to provide access to experimental drugs as “pointless grandstanding in the face of a pandemic that requires a public health response.”
In her feature this week Sophie Arie considers WHO’s support of clinical trials for experimental drugs as a bottle half full rather than empty (doi:10.1136/bmj.h1938). A year after the first case of Ebola virus disease was reported, several phase II and III trials of vaccines and other treatments are under way—“a process that normally can take as long as 10 years was compressed into a year.”
At least a dozen other neglected infectious disease pathogens have the potential to pose a similar threat to Ebola, and Arie describes how an international group of scientists has argued for fast tracking experimental vaccines and treatments for these, so that they’re available at the beginning of a disease outbreak. Such long range thinking comes as a welcome alternative to the attention deficit that usually afflicts the disasterazzi, as they flit from one trouble spot to the next…

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Editorials
Ebola and ethics: autopsy of a failure
BMJ 2015; 350 doi: http://dx.doi.org/10.1136/bmj.h2105 (Published 23 April 2015) Cite this as: BMJ 2015;350:h2105
Christian A Gericke, chief executive and director of research
Author affiliations
Thousands died while we argued over the wrong questions

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Feature – Vaccines
Ebola: a game changer for vaccines, or a scare that will soon be forgotten?
BMJ 2015; 350 doi: http://dx.doi.org/10.1136/bmj.h1938 (Published 06 May 2015) Cite this as: BMJ 2015;350:h1938
Sophie Arie
Scientists say that it is only a matter of time before another neglected infectious disease causes a global public health emergency. So will the world now make these diseases a priority? Sophie Arie reports

Chronicle of Philanthropy
May 4, 2015 Volume 27, Issue 9
https://philanthropy.com/issue
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Cover Story
May 01, 2015
Online Giving’s Time Has Come, Like It or Not
Many nonprofits see online giving as little more than a gimmick. But it may hold the key to strengthening ties with donors.
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May 04, 2015
A ‘Yelp’ for Migrant Workers
Rachel Micah Jones’s small charity is helping laborers fight back online against exploitation.
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May 04, 2015
Unicef Builds a Bridge Fund
The group’s system for making short-term internal loans while it waits for pledges to come through helps it fulfill needs as they arise.

Complexity
May/June 2015 Volume 20, Issue 5 Pages C1–C1, 1–76
http://onlinelibrary.wiley.com/doi/10.1002/cplx.v20.5/issuetoc

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The Simply Complex
Ebola—challenge and revival of theoretical epidemiology: Why Extrapolations from early phases of epidemics are problematic
Peter Schuster*
Article first published online: 28 APR 2015
DOI: 10.1002/cplx.21694
[Initial text]
At the beginning of the second half of the 20th century, there was a widespread belief that science and in particular medicine had progressed so far that Nature could be brought under complete control. It seemed that healthcare and pharmacology were in the position to prevent or to cure almost all diseases. In the 1980s, for example, the pharmaceutical industry stopped the search for new antibiotic drugs that would be badly needed nowadays in the light of the universal capabilities of bacteria to develop resistance factors. At about the same time previously unknown or unnoticed virus transmitted infectious human diseases appeared: acquired immunodeficiency syndrome caused by human immunodeficiency virus (HIV), Ebola caused by Ebola virus (EBOV) and four related other strains of filoviridae, as well as severe acquired respiratory syndrome (SARS) brought about by SARS coronavirus. Caused by prions and not by a virus is been bovine spongiform encephalopathy (BSE). Nevertheless, it gave rise to an equally serious new epidemic. These and other cases as well as the consequences of the “antivaccination movement” [1, 2], for example, the recent reoccurrence of pertussis and measles, revived a need of reliable models in epidemiology. In particular, the recent Ebola epidemic starting in December 2013 in West Africa [3] initiated a new boom in theoretical work on infectious disease dynamics [4]. In PLoS Currents Outbreaks I counted 27 articles between the first publication on the recent Ebola epidemics on May 02, 2014 until March 09, 2015. In December 2014, researchers became aware that the predictions made 3 months earlier, in Fall 2014, apparently overstated the numbers of cases and deaths. A recent theoretical paper aims at an analysis of the prediction errors and provides suggestions how to make better forecasts [5]. In this essay, we shall be concerned with the predictive power of one frequently used model denoted as susceptible-exposed-infectious-removed (SEIR) model, and try to analyze typical general problems of predictions from early stages of exponentially growing systems to the final outcomes of the processes. In the focus are the model inherent limitations of reliabilities and not the lack of information or external problems like insufficient data or the uncertainty about the effectiveness of intervention strategies or countermeasures…

Conflict and Health
[Accessed 9 May 2015]
http://www.conflictandhealth.com/

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Letter to Editor
Access to healthcare for the most vulnerable migrants: a humanitarian crisis
Kevin Pottie1*, Jorge Pedro Martin2, Stephen Cornish3, Linn Maria Biorklund4, Ivan Gayton5, Frank Doerner6 and Fabien Schneider3
Author Affiliations
Conflict and Health 2015, 9:16 doi:10.1186/s13031-015-0043-8
Published: 7 May 2015
Abstract (provisional)
A series of Médecins Sans Frontières projects over the past decade have consistently documented high rates of physical and sexual trauma, extortion and mental illness amidst severe healthcare, food, and housing limitations. Complex interventions were needed to begin to address illness and barriers to healthcare and to help restore dignity to the most vulnerable women, children and men. Promising interventions included mobile clinics, use of cultural mediators, coordination with migrant-friendly entities and NGOs and integrating advocacy programs and mental health care with medical services. Ongoing interventions, research and coordination are needed to address this neglected humanitarian crisis.

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 9 May 2015]

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Research
Medicines availability for non-communicable diseases: the case for standardized monitoring
Jane Robertson12*, Cécile Macé1, Gilles Forte1, Kees de Joncheere1 and David Beran34
Author Affiliations
Globalization and Health 2015, 11:18 doi:10.1186/s12992-015-0105-0
Published: 7 May 2015
Abstract (provisional)
Background
In response to the global burden of non-communicable diseases (NCDs), the World Health Organization (WHO) has developed a Global Action Plan that includes a voluntary medicines target of 80% availability and affordability of essential medicines for the prevention and treatment of diabetes, cardiovascular disease and respiratory disease both in public and private health facilities. Reliable measures of medicines availability are needed to track progress towards meeting this target. The results of three studies measuring the availability of medicines for hypertension and diabetes conducted in Tanzania in 2012–2013 were compared to assess the consistency of the results across the studies.
Methods
Availability was defined by observation of the medicine (no minimum quantity) on the day of the survey. The three studies involved 24, 107 and 1297 health facilities. Estimates of the availability of medicines for hypertension and diabetes were compared for medicines availability overall, by managing authority (government, mission/faith-based, private-for-profit), by facility level (hospital, health centre, dispensary) and by setting (urban, rural).
Results
Comparisons of the availability of medicines were limited by differences in the definitions of the medicines and the classifications of the facilities surveyed. Metformin was variously reported as available in 33%, 39%, 46%, and 57% of facilities. Glibenclamide availability ranged from 19% to 52%. One study reported low levels of insulin availability (9-16% depending on insulin type) compared to 34% in a second study. Captopril (or angiotensin converting enzyme [ACE] inhibitor) availability ranged from 13% to 48%while availability of calcium channel blockers was 29% to 57% and beta-blockers 15% to 50%. Trends were similar across studies with lower availability in government compared to mission or private facilities, in dispensary and health centres compared to hospitals, and in rural compared to urban facilities.
Conclusions
All three studies showed suboptimal availability of NCD medicines, however the estimates of availability differed. Regular monitoring using reproducible methods and measuring key medicines must replace ad-hoc studies, small selected samples and differences in definitions. Low and middle-income countries need to implement monitoring and evaluation systems to track progress towards meeting the NCD medicines target and to inform country-level interventions to improve access to NCD medicines.

Health Policy and Planning
Volume 30 Issue 5 June 2015
http://heapol.oxfordjournals.org/content/current

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Innovations in communication technologies for measles supplemental immunization activities: lessons from Kenya measles vaccination campaign, November 2012
William B Mbabazi1,*, Collins W Tabu2, Caleb Chemirmir3, James Kisia3, Nasra Ali3, Melissa G Corkum4 and Gene L Bartley5
Author Affiliations
1American Red Cross International Response and Programs, PO Box 41275-00100, Nairobi, Kenya, 2Division of Vaccines and Immunization, Ministry of Health, PO Box 30016, Nairobi, Kenya, 3Kenya Red Cross, PO Box 40712-00100, Nairobi, Kenya, 4UNICEF East and Southern African Regional Office, United Nations Complex, Gigiri, PO Box 44145-00100, Nairobi, Kenya and 5Bill and Melinda Gates Foundation, PO Box 45335-00100 Nairobi, Kenya
Accepted April 20, 2014.
Abstract
Background
To achieve a measles free world, effective communication must be part of all elimination plans. The choice of communication approaches must be evidence based, locally appropriate, interactive and community owned. In this article, we document the innovative approach of using house visits supported by a web-enabled mobile phone application to create a real-time platform for adaptive management of supplemental measles immunization days in Kenya.
Methods
One thousand nine hundred and fifty-two Red Cross volunteers were recruited, trained and deployed to conduct house-to-house canvassing in 11 urban districts of Kenya. Three days before the campaigns, volunteers conducted house visits with a uniform approach and package of messages. All house visits were documented using a web-enabled mobile phone application (episurveyor) that in real-time relayed information collected to all campaign management levels. During the campaigns, volunteers reported daily immunizations to their co-ordinators. Post-campaign house visits were also conducted within 4 days, to verify immunization of eligible children, assess information sources and detect adverse events following immunization.
Results
Fifty-six per cent of the 164,643 households visited said that they had heard about the planned 2012 measles vaccination campaign 1–3 days before start dates. Twenty-five per cent of households were likely to miss the measles supplemental dose if they had not been reassured by the house visit. Pre- and post-campaign reasons for refusal showed that targeted communication reduced misconceptions, fear of injections and trust in herbal remedies. Daily reporting of immunizations using mobile phones informed changes in service delivery plans for better immunization coverage. House visits were more remembered (70%) as sources of information compared with traditional mass awareness channels like megaphones (41%) and radio (37%).
Conclusions
In high-density settlements, house-to-house visits are easy and more penetrative compared with traditional media approaches. Using mobile phones to document campaign processes and outputs provides real time evidence for service delivery planning to improve immunization coverage.

Health Policy and Planning
Volume 30 Issue 5 June 2015
http://heapol.oxfordjournals.org/content/current

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Determinants of HIV testing among Nigerian couples: a multilevel modelling approach
Aurélia Lépine*, Fern Terris-Prestholt and Peter Vickerman
Author Affiliations
London School of Hygiene and Tropical Medicine, Global Health and Development Department, London, WC1H 9SH, UK
Accepted April 5, 2014.
Abstract
In this article we analyse the determinants of HIV testing among Nigerian couples using Demographic and Health Survey data set (2008). This study is motivated by the fact that although there is a strong willingness from the Nigerian Government to examine new HIV preventions approaches such as Pre-Exposure Prophylaxis for HIV (PrEP) and Treatment as Prevention (TasP) for HIV serodiscordant couples, the implementation of such policies would require the HIV status of each partner in the couple to be known. This is far to be achieved in the Nigerian context since in Nigeria only 6% of couples know their HIV status. In order to identify potential policies that are needed to increase HIV testing uptake, we use a three-level random intercept logistic model to separately explore the determinants of knowing HIV status among female and male partners. The use of the multilevel modelling allows including the unobserved heterogeneity at the village and state level that may affect HIV testing behaviours. Our results indicate that education, wealth, stigma, HIV knowledge and perceived risk are predictors of HIV testing among both partners while routine provider initiated testing appears to be very effective to increase HIV testing among women. The introduction of financial incentives as well as an increase in routine testing and home-based testing may be needed for large scale increase in HIV testing prior to the implementation of new HIV prevention technologies among discordant couples.

Health Policy and Planning
Volume 30 Issue 5 June 2015
http://heapol.oxfordjournals.org/content/current

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Measuring political commitment and opportunities to advance food and nutrition security: piloting a rapid assessment tool
Ashley M Fox1,*, Yarlini Balarajan2, Chloe Cheng3 and Michael R Reich4
Author Affiliations
1Department of Health Evidence and Policy, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029, USA and 2Nutrition Section, Programme Division, United Nations Children’s Fund (UNICEF), Three United Nations Plaza, New York, NY 10017, USA, 3Department of Health Evidence and Policy, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029, USA, 4Department of Global Health and Population, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA
Accepted April 6, 2014.
Abstract
Lack of political commitment has been identified as a primary reason for the low priority that food and nutrition interventions receive from national governments relative to the high disease burden caused by malnutrition. Researchers have identified a number of factors that contribute to food and nutrition’s ‘low-priority cycle’ on national policy agendas, but few tools exist to rapidly measure political commitment and identify opportunities to advance food and nutrition on the policy agenda. This article presents a theory-based rapid assessment approach to gauging countries’ level of political commitment to food and nutrition security and identifying opportunities to advance food and nutrition on the policy agenda. The rapid assessment tool was piloted among food and nutrition policymakers and planners in 10 low- and middle-income countries in April to June 2013. Food and nutrition commitment and policy opportunity scores were calculated for each country and strategies to advance food and nutrition on policy agendas were designed for each country. The article finds that, in a majority of countries, political leaders had verbally and symbolically committed to addressing food and nutrition, but adequate financial resources were not allocated to implement specific programmes. In addition, whereas the low cohesion of the policy community has been viewed a major underlying cause of the low-priority status of food and nutrition, the analysis finds that policy community cohesion and having a well thought-out policy alternative were present in most countries. This tool may be useful to policymakers and planners providing information that can be used to benchmark and/or evaluate advocacy efforts to advance reforms in the food and nutrition sector; furthermore, the results can help identify specific strategies that can be employed to move the food and nutrition agenda forward. This tool complements others that have been recently developed to measure national commitment to advancing food and nutrition security.

Health Policy and Planning
Volume 30 Issue 5 June 2015
http://heapol.oxfordjournals.org/content/current

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The cost of a knowledge silo: a systematic re-review of water, sanitation and hygiene interventions
Michael Loevinsohn1,*, Lyla Mehta1,2, Katie Cuming1, Alan Nicol1,4, Oliver Cumming3 and
Jeroen H J Ensink3
Author Affiliations
1Knowledge, Technology and Society Team, Institute of Development Studies, Library Road, Brighton BN1 9RE, UK, 2Noragric, Norwegian University of Life Sciences, P.O. Box 5003, NO-1432 Aas, Norway, 3Environmental Health Group, Department of Disease Control, Faculty of Infectious Tropical Disease, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT and 4Present address: CARE International in Uganda, Box 7280 Kampala, Uganda
Accepted April 5, 2014.
Abstract
Divisions between communities, disciplinary and practice, impede understanding of how complex interventions in health and other sectors actually work and slow the development and spread of more effective ones. We test this hypothesis by re-reviewing a Cochrane-standard systematic review (SR) of water, sanitation and hygiene (WASH) interventions’ impact on child diarrhoea morbidity: can greater understanding of impacts and how they are achieved be gained when the same papers are reviewed jointly from health and development perspectives? Using realist review methods, researchers examined the 27 papers for evidence of other impact pathways operating than assumed in the papers and SR. Evidence relating to four questions was judged on a scale of likelihood. At the ‘more than possible’ or ‘likely’ level, 22% of interventions were judged to involve substantially more actions than the SR’s label indicated; 37% resulted in substantial additional impacts, beyond reduced diarrhoea morbidity; and unforeseen actions by individuals, households or communities substantially contributed to the impacts in 48% of studies. In 44%, it was judged that these additional impacts and actions would have substantially affected the intervention’s effect on diarrhoea morbidity. The prevalence of these impacts and actions might well be found greater in studies not so narrowly selected. We identify six impact pathways suggested by these studies that were not considered by the SR: these are tentative, given the limitations of the literature we reviewed, but may help stimulate wider review and primary evaluation efforts. This re-review offers a fuller understanding of the impacts of these interventions and how they are produced, pointing to several ways in which investments might enhance health and wellbeing. It suggests that some conclusions of the SR and earlier reviews should be reconsidered. Moreover, it contributes important experience to the continuing debate on appropriate methods to evaluate and synthesize evidence on complex interventions.

Health Policy and Planning
Volume 30 Issue 5 June 2015
http://heapol.oxfordjournals.org/content/current

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Monitoring the ability to deliver care in low- and middle-income countries: a systematic review of health facility assessment tools
Jason W Nickerson1,2,*, Orvill Adams3, Amir Attaran4,5, Janet Hatcher-Roberts6 and Peter Tugwell7
Author Affiliations
1Institute of Population Health, University of Ottawa, Ottawa, ON, Canada, 2Bruyère Research Institute, Ottawa, ON, Canada, 3Orvill Adams and Associates, Ottawa, ON, Canada, 4Faculty of Common Law, University of Ottawa, Ottawa, ON, Canada, 5Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada, 6Canadian Society for International Health, Ottawa, ON, Canada and 7Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
Accepted April 25, 2014.
Abstract
Introduction
Health facilities assessments are an essential instrument for health system strengthening in low- and middle-income countries. These assessments are used to conduct health facility censuses to assess the capacity of the health system to deliver health care and to identify gaps in the coverage of health services. Despite the valuable role of these assessments, there are currently no minimum standards or frameworks for these tools.
Methods
We used a structured keyword search of the MEDLINE, EMBASE and HealthStar databases and searched the websites of the World Health Organization, the World Bank and the International Health Facilities Assessment Network to locate all available health facilities assessment tools intended for use in low- and middle-income countries. We parsed the various assessment tools to identify similarities between them, which we catalogued into a framework comprising 41 assessment domains.
Results
We identified 10 health facility assessment tools meeting our inclusion criteria, all of which were included in our analysis. We found substantial variation in the comprehensiveness of the included tools, with the assessments containing indicators in 13 to 33 (median: 25.5) of the 41 assessment domains included in our framework. None of the tools collected data on all 41 of the assessment domains we identified.
Conclusions
Not only do a large number of health facility assessment tools exist, but the data they collect and methods they employ are very different. This certainly limits the comparability of the data between different countries’ health systems and probably creates blind spots that impede efforts to strengthen those systems. Agreement is needed on the essential elements of health facility assessments to guide the development of specific indicators and for refining existing instruments.

Health Policy and Planning
Volume 30 Issue 5 June 2015
http://heapol.oxfordjournals.org/content/current

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Sexual violence in India: addressing gaps between policy and implementation
Prachi Sharma1, M K Unnikrishnan1 and Abhishek Sharma1,2,*
Author Affiliations
1Manipal College of Pharmaceutical Sciences, Manipal University, Madhav Nagar, Manipal 576104, Karnataka, India, 2Department of International Health, Boston University School of Public Health, 715 Albany Street, Boston, Massachusetts 02118, United States of America
Accepted February 6, 2014.
Abstract
The savage Delhi rape of 16 December 2012 was instrumental in generating the Verma Report that framed policies for amending the Criminal Laws related to sexual violence, professionalizing forensic/medical examination of victims, and sensitizing the police, electorate and the educational sectors. Unfortunately, even after a year, the Indian Home Ministry has abysmally failed to implement most recommendations, even underutilizing budgetary allocations. This article addresses gaps in governance systems and offers solutions to the problem of sexual violence in India.

Journal of Community Health
Volume 40, Issue 3, June 2015
http://link.springer.com/journal/10900/40/3/page/1

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Latino Parents’ Perceptions of the HPV Vaccine for Sons and Daughters
Echo L. Warner, Djin Lai, Sara Carbajal-Salisbury, Luis Garza, Julia Bodson, Kathi Mooney,
Deanna Kepka
Abstract
Latinas have the highest incidence of cervical cancer. Latino parents’ perceptions of the human papillomavirus (HPV) and willingness to have their sons and daughters vaccinated in Utah is largely unknown. Latino parents/guardians of children ages 11–17 years were recruited from two community organizations (N = 52) to participate in a mini-survey and focus group. Guided by the social ecological framework, a Latina facilitator conducted five focus groups that were recorded, transcribed and translated. Descriptive statistics were calculated from the mini-survey. Two members of the research team performed inductive content analysis of the focus group transcriptions separately. Discrepancies were discussed and resolved during bi-weekly meetings with group members who were present during the focus groups. Parents reported low HPV vaccine knowledge, high vaccine costs, and lack of strong provider recommendations as the main barriers to vaccine receipt. Language appropriate educational resources and consistent provider recommendations may enrich Latino parents’ perceptions about the HPV vaccine.

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HPV Vaccination Completion and Compliance with Recommended Dosing Intervals Among Female and Male Adolescents in an Inner-City Community Health Center
Rula M. Wilson, Diane R. Brown, Dennis P. Carmody, Sushanna Fogarty
Abstract
Human papillomavirus (HPV) vaccination continues to lag behind other adolescent vaccines, especially in areas with pervasive disparities in HPV-related cancers. The purpose of this study was to examine HPV vaccine completion and dosing intervals among low-income adolescents in urban areas. The study included electronic health record data on HPV vaccination for 872 adolescents who received at least one dose of the HPV vaccine. Only 28.4 % completed the 3-dose series. For the whole sample, HPV vaccine completion was higher for non-English speakers and among adolescents seen at Newark-South and East Orange sites. Completion was higher among non-English speaking female and Hispanic adolescents, females seen in Newark-South and East Orange sites, and insured Black adolescents. Completion was also dramatically lower among non-English speaking Black adolescents seen at Newark-North, Irvington, and Orange sites (12.5 %) compared to other Black adolescents (22.0–44.4 %). The mean dosing intervals were 5.5 months (SD = 4.6) between dose 1 and 2 and 10 months (SD = 6.1) between dose 1 and 3. Longer durations between vaccine doses were found among uninsured adolescents and those seen at Newark-North, Irvington, and Orange sites. Non-English speakers had longer duration between dose 1 and 3. Further, durations between dose 1 and 3 were dramatically longer among insured adolescents seen at Newark-North, Irvington, and Orange locations for the whole sample (M = 11.70; SD = 7.12) and among Hispanic adolescents (M = 13.45; SD = 8.54). Understanding how the study predictors facilitate or impede HPV vaccination is critical to reducing disparities in cervical and other HPV-related cancer, especially among Black, Hispanic, and low-income populations.

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Knowledge Management for Development Journal
Vol 11, No 1 (2015)
http://journal.km4dev.org/journal/index.php/km4dj/index

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The Facilitator Role within Learning Networks at USAID
Ashleigh Mullinax, Cydney Gumann
Abstract
How can facilitation help to drive meaningful peer-to-peer learning in a formalized learning network? This article will explore the core role that facilitators play in implementing a learning network, as defined by USAID. USAID’s model of learning networks differs from other peer-to-peer learning opportunities, such as communities of practice or networks of practice, in a number of ways including selection of grantees through a competitive process, dedicated funding of learning network partners, and creation of deliverables within a designated timeline. This paper outlines three core differences that make facilitating learning networks at USAID distinctive: 1) The organization of the learning network around evolving learning agendas that facilitate learning on multiple levels; 2) The time and process involved in the development and implementation of a learning network; and 3) The unique intra- and inter-personal dynamics of the learning network through the involvement of both the funded (network members) and the funder (the donor). In this article, the role of a learning network facilitator will be overlaid primarily with lessons learned generated from implementation of the Growing Organizational Value Chain Excellence (GROOVE) Learning Network.

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Group facilitation in CGIAR: experiences and lessons from international agricultural research organizations
Simone Staiger, Ewen Le Borgne, Michael Victor, Juergen Hagmann, Cristina Sette, Petr Kosina
Abstract
This article describes CGIAR’s experience with group facilitation over 10 years. CGIAR is a global partnership that unites organizations engaged in research for a food-secure future. Including 15 research centers with a total of nearly 9,000 staff, CGIAR embarked a decade ago on an effort to improve how teams meet, think collectively, and make decisions. Inspired by participatory approaches, which had been used since the 1980s to involve farmers in research, the leaders of this effort aimed to tackle challenges faced by research teams and partnerships, and since then, the need for more effective stakeholder engagement and the consequent demand for group facilitation have steadily increased. Based on the experiences of the co-authors, a survey, complemented by follow-up conversations with CGIAR in-house facilitators and researchers, as well as professional consultant-facilitators and partners, this case study analyzes the evolution of facilitation, its added value, and current trends. In addition, the authors discuss the different ways and contexts in which facilitators have worked in CGIAR and some of the facilitation essentials that emerge from the author’s enquiry. This article should be of particular interest to knowledge management practitioners working in research and development, as it offers hints on how to position facilitation as an essential tool for stakeholder engagement and participatory decision-making in research-for-development organizations.
Full Text: PDF

The Lancet
May 09, 2015 Volume 385 Number 9980 p1803-1916 e45-e46
http://www.thelancet.com/journals/lancet/issue/current

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Editorial
Rural health inequities: data and decisions
The Lancet
DOI: http://dx.doi.org/10.1016/S0140-6736(15)60910-2
70% of the world’s 1.4 billion people who are extremely poor live in rural areas. A new report released on April 27 by the UN International Labour Organisation (ILO), Global evidence on inequities in rural health protection: new data on rural deficits in health coverage for 174 countries, presents the first global, regional, and national data on the extent and major causes of rural–urban inequities in coverage, and access to health care. 56% of rural residents worldwide are without legal health coverage (defined as protected by legislation or affiliation with a health insurance scheme)—compared with 22% of the urban population.

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Editorial
Keeping watch on women’s cancers
The Lancet
DOI: http://dx.doi.org/10.1016/S0140-6736(15)60911-4
Cancer is a perennial public health issue. With refined estimates of the global burden of disease (GBD), the picture of cancer has become clearer and has begun to yield crucial new details about where the challenges lie. According to the 2013 GBD study, the cancers that contribute to the most deaths are: lung (1•64 million), stomach (840 000), liver (820 000), colorectal (770 000), and breast (470 000). But other areas of concern emerge when aggregating across types of cancer, such as cancers that specifically affect women.

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Comment
Global health security now
Richard Horton, Pamela Das
DOI: http://dx.doi.org/10.1016/S0140-6736(15)60909-6
The concept of security as an important dimension of health divides opinions. To invoke the idea of security risks giving permission to more authoritarian-minded governments to use health crises as justification for sometimes extreme curbs on liberty or the political, economic, and social rights of citizens. During the Ebola virus disease outbreak, photographs appeared in news media of police brutally attacking the public for breaching curfews. Invoking arguments of global health security might further encourage this kind of violent response.

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Comment
Putting science into practice for early child development
Anthony Lake, Margaret Chan
DOI: http://dx.doi.org/10.1016/S0140-6736(14)61680-9
The debate between nature and nurture as determinants of early child development is over. Today, we understand that the two are inextricably linked. The degree of their interdependence—and the impact of this interplay on the developing brains of children—is even greater than we previously imagined.1 This knowledge has tremendous implications for how we design and deliver early child development interventions…

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Public Policy
Global health security: the wider lessons from the west African Ebola virus disease epidemic
Prof David L Heymann, MD, Lincoln Chen, MD, Prof Keizo Takemi, MA, Prof David P Fidler, BCL, Jordan W Tappero, MD, Mathew J Thomas, MPH, Thomas A Kenyon, MD, Thomas R Frieden, MD, Derek Yach, MBChB, Sania Nishtar, FRCP, Alex Kalache, Prof Piero L Olliaro, MD, Prof Peter Horby, MD, Els Torreele, PhD, Prof Lawrence O Gostin, JD, Margareth Ndomondo-Sigonda, MBA, Prof Daniel Carpenter, PhD, Simon Rushton, PhD, Louis Lillywhite, MSc, Prof Bhimsen Devkota, PhD, Prof Khalid Koser, PhD, Rob Yates, MBA ,Ranu S Dhillon, MD, Ravi P Rannan-Eliya, DPH
DOI: http://dx.doi.org/10.1016/S0140-6736(15)60858-3
Summary
The Ebola virus disease outbreak in West Africa was unprecedented in both its scale and impact. Out of this human calamity has come renewed attention to global health security—its definition, meaning, and the practical implications for programmes and policy. For example, how does a government begin to strengthen its core public health capacities, as demanded by the International Health Regulations? What counts as a global health security concern? In the context of the governance of global health, including WHO reform, it will be important to distil lessons learned from the Ebola outbreak. The Lancet invited a group of respected global health practitioners to reflect on these lessons, to explore the idea of global health security, and to offer suggestions for next steps. Their contributions describe some of the major threats to individual and collective human health, as well as the values and recommendations that should be considered to counteract such threats in the future. Many different perspectives are proposed. Their common goal is a more sustainable and resilient society for human health and wellbeing.

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Public Policy
A retrospective and prospective analysis of the west African Ebola virus disease epidemic: robust national health systems at the foundation and an empowered WHO at the apex
Prof Lawrence O Gostin, JD, Eric A Friedman, JD
DOI: http://dx.doi.org/10.1016/S0140-6736(15)60644-4
Summary
The Ebola virus disease outbreak in west Africa is pivotal for the worldwide health system. Just as the depth of the crisis ultimately spurred an unprecedented response, the failures of leadership suggest the need for innovative reforms. Such reforms would transform the existing worldwide health system architecture into a purposeful, organised system with an empowered, highly capable WHO at its apex and enduring, equitable national health systems at its foundation. It would be designed not only to provide security against epidemic threats, but also to meet everyday health needs, thus realising the right to health. This retrospective and prospective analysis offers a template for these reforms, responding to the profound harms posed by fragile national health systems, delays in the international response, deficient resource mobilisation, ill defined responsibilities, and insufficient coordination. The scope of the reforms should address failures in the Ebola response, and entrenched weaknesses that enabled the epidemic to reach its heights.

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Viewpoint
What is a resilient health system? Lessons from Ebola
Margaret E Kruk, Michael Myers, S Tornorlah Varpilah, Bernice T Dahn
Ebola vaccines: keep the clinical trial protocols on the shelf and ready to roll out
David L Heymann, Guenael R Rodier, Michael J Ryan

PLOS Currents: Disasters
[Accessed 9 May 2015]
http://currents.plos.org/disasters/

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Foreign Medical Teams in the Philippines after Typhoon Haiyan 2013 – Who Were They, When Did They Arrive and What Did They Do?
May 5, 2015 • Research article
Background:
Foreign medical teams (FMT) are international medical teams sent to provide assistance in the aftermath of a disaster. In the last decade, there has been an increase in FMTs deployed following disasters. Despite the potential benefit FMTs might have in substituting the collapsed health care and caring for excess morbidity after large-scale disasters, several studies have demonstrated the difficulties in determining the quality of the response, mainly due to lack of reliable data. In order to bridge the knowledge gap on functioning of FMTs, the aim of this study is to assess the timing, capacities and activities of FMTs deployed to the Philippines after typhoon Haiyan.
Methods:
This is a retrospective, descriptive study. Data on characteristics of FMTs present in the Philippines after typhoon Haiyan was provided by the World Health Organization (WHO) and compiled into a single database. Additional data was collected through a web survey, email correspondence and internet searches.
Results:
A total of 108 FMTs were identified as arriving to the Philippines within the first month following typhoon Haiyan. None of these were operational in the affected areas within the first 72 h and the average time between arriving and being on-site operational was three days. Of the 108 FMTs, 70% were FMT type 1, 11% were FMT type 2 and 3% were FMT type 3. 16% of FMTs had unknown status. The total number of staff within all these FMTs were 2121, of which 210 were medical doctors, 250 nurses and 6 midwifes. Compared to previous sudden onset disasters, this study found no improvement in data sharing.

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
(Accessed 9 May 2015)

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Assessing Measles Transmission in the United States Following a Large Outbreak in California
May 7, 2015 • Research
The recent increase in measles cases in California may raise questions regarding the continuing success of measles control. To determine whether the dynamics of measles is qualitatively different in comparison to previous years, we assess whether the 2014-2015 measles outbreak associated with an Anaheim theme park is consistent with subcriticality by calculating maximum-likelihood estimates for the effective reproduction number given this year’s outbreak, using the Galton-Watson branching process model. We find that the dynamics after the initial transmission event are consistent with prior transmission, but does not exclude the possibilty that the effective reproduction number has increased.

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Epidemiological and Surveillance Response to Ebola Virus Disease Outbreak in Lofa County, Liberia (March-September, 2014); Lessons Learned
May 6, 2015 • Research
Ebola Virus Disease (EVD) outbreak was confirmed in Liberia on March 31st 2014. A response comprising of diverse expertise was mobilized and deployed to the country to contain transmission of Ebola and give relief to a people already impoverished from protracted civil war. This paper describes the epidemiological and surveillance response to the EVD outbreak in Lofa County in Liberia from March to September 2014. Five of the 6 districts of Lofa were affected. The most affected districts were Voinjama/Guardu Gbondi and Foya. By 26th September, 2014, a total of 619 cases, including 19.4% probable cases, 20.3% suspected cases and 44.2% confirmed cases were recorded by the Ebola Emergency Response Team (EERT) of Lofa County. Adults (20-50 years) were the most affected. Overall fatality rate was 53.3%. Twenty two (22) cases were reported among the Health Care Workers with a fatality rate of 81.8%. Seventy eight percent (78%) of the contacts successfully completed 21 days follow-up while 134 (6.15%) that developed signs and symptoms of EVD were referred to the ETU in Foya. The contributions of the weak health systems as well as socio-cultural factors in fueling the epidemic are highlighted. Importantly, the lessons learnt including the positive impact of multi-sectorial and multidisciplinary and coordinated response led by the government and community. Again, given that the spread of infectious disease can be considered a security threat every effort has to put in place to strengthen the health systems in developing countries including the International Health Regulation (IHR)’s core capacities.

PLoS Medicine
(Accessed 9 May 2015)
http://www.plosmedicine.org/

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Essay
Screening and Treating UN Peacekeepers to Prevent the Introduction of Artemisinin-Resistant Malaria into Africa
Stan Houston, Adam Houston
Published: May 5, 2015
DOI: 10.1371/journal.pmed.1001822
Summary Points
:: The Haitian cholera epidemic provides a tragic demonstration of the potential for United Nations peacekeepers to introduce serious disease into vulnerable populations.
:: Resistance to artemisinin derivatives, now the global standard therapy for falciparum malaria, has emerged and is spreading in Southeast Asia.
:: UN peacekeeping troops from Southeast Asia are frequently deployed in sub-Saharan Africa.
:: These circumstances entail a high risk of introducing artemisinin resistance into the populations most affected by malaria, with potentially disastrous consequences for malaria treatment and control in sub-Saharan Africa.
:: The UN has a responsibility to prevent such an outcome; selective predeployment screening and treatment of UN peacekeeping troops is feasible and urgently needed.
Introduction: The Precedent of Cholera in Haiti
In the aftermath of the massive earthquake that devastated Haiti in 2010, an ongoing epidemic of cholera introduced by United Nations peacekeepers has resulted in over 730,000 cases and over 8,700 deaths—the largest single-country cholera epidemic in nearly a century [1,2]. This disaster should serve as an urgent warning about the potential for introduction by UN troops of other serious infectious diseases into the vulnerable populations they were sent to protect. Indeed, the UN has recently agreed to avoid rotation of African troops to Haiti because of concern about the introduction of Ebola [3]. But the tragedy in Haiti pales in comparison to the scale of long-term impact on malaria morbidity, mortality, and control programs that would result from the introduction of artemisinin-resistance into sub-Saharan Africa, where 85% of the world’s falciparum malaria cases and over 90% of all malaria deaths now occur [4]. This threat demands urgent action, in particular on the part of the UN…

PLoS One
[Accessed 9 May 2015]
http://www.plosone.org/

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Millennium Development Goal Four and Child Health Inequities in Indonesia: A Systematic Review of the Literature
Julia Schröders, Stig Wall, Hari Kusnanto, Nawi Ng
Research Article | published 05 May 2015 | PLOS ONE 10.1371/journal.pone.0123629
Abstract
Introduction
Millennium Development Goal (MDG) 4 calls for reducing mortality of children under-five years by two-thirds by 2015. Indonesia is on track to officially meet the MDG 4 targets by 2015 but progress has been far from universal. It has been argued that national level statistics, on which MDG 4 relies, obscure persistent health inequities within the country. Particularly inequities in child health are a major global public health challenge both for achieving MDG 4 in 2015 and beyond. This review aims to map out the situation of MDG 4 with respect to disadvantaged populations in Indonesia applying the Social Determinants of Health (SDH) framework. The specific objectives are to answer: Who are the disadvantaged populations? Where do they live? And why and how is the inequitable distribution of health explained in terms of the SDH framework?
Methods and Findings
We retrieved studies through a systematic review of peer-reviewed and gray literature published in 1995-2014. The PRISMA-Equity 2012 statement was adapted to guide the methods of this review. The dependent variables were MDG 4-related indicators; the independent variable “disadvantaged populations” was defined by different categories of social differentiation using PROGRESS. Included texts were analyzed following the guidelines for deductive content analysis operationalized on the basis of the SDH framework. We identified 83 studies establishing evidence on more than 40 different determinants hindering an equitable distribution of child health in Indonesia. The most prominent determinants arise from the shortcomings within the rural health care system, the repercussions of food poverty coupled with low health literacy among parents, the impact of low household decision-making power of mothers, and the consequences of high persistent use of traditional birth attendants among ethnic minorities.
Conclusion
This review calls for enhanced understanding of the determinants and pathways that create, detain, and overcome inequities in child health in resource constraint settings like Indonesia and the promotion of actionable health policy recommendations and tailored investments.

Science
8 May 2015 vol 348, issue 6235, pages 605-728
http://www.sciencemag.org/current.dtl

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Report
Long-term measles-induced immunomodulation increases overall childhood infectious disease mortality
Michael J. Mina1,2,*, C. Jessica E. Metcalf1,3, Rik L. de Swart4, A. D. M. E. Osterhaus4, Bryan T. Grenfell1,3
Author Affiliations
1Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA.
2Medical Scientist Training Program, School of Medicine, Emory University, Atlanta, GA, USA.
3Fogarty International Center, National Institutes of Health, Bethesda, MD, USA.
4Department of Viroscience, Erasmus University Medical Center, Rotterdam, Netherlands.
Abstract
Immunosuppression after measles is known to predispose people to opportunistic infections for a period of several weeks to months. Using population-level data, we show that measles has a more prolonged effect on host resistance, extending over 2 to 3 years. We find that nonmeasles infectious disease mortality in high-income countries is tightly coupled to measles incidence at this lag, in both the pre- and post-vaccine eras. We conclude that long-term immunologic sequelae of measles drive interannual fluctuations in nonmeasles deaths. This is consistent with recent experimental work that attributes the immunosuppressive effects of measles to depletion of B and T lymphocytes. Our data provide an explanation for the long-term benefits of measles vaccination in preventing all-cause infectious disease. By preventing measles-associated immune memory loss, vaccination protects polymicrobial herd immunity.

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Review
Soil and human security in the 21st century
Ronald Amundson1,*, Asmeret Asefaw Berhe2, Jan W. Hopmans3, Carolyn Olson4, A. Ester Sztein5, Donald L. Sparks6
Author Affiliations
1Department of Environmental Science, Policy, and Management, University of California, Berkeley, CA 94720, USA.
2Life and Environmental Sciences Unit, University of California, Merced, CA 95343, USA.
3Land, Air, and Water Resources, One Shields Avenue, Davis, CA 95616, USA.
4Climate Change Program Office, Office of the Chief Economist, U.S. Department of Agriculture (USDA), 14th and Independence SW, Washington, DC 20013, USA.
5Board on International Scientific Organizations, National Academy of Sciences, 500 Fifth Street NW, Washington, DC 20001, USA.
6Plant and Soil Science, Chemistry and Biochemistry, Civil and Environmental Engineering, and Marine Science and Policy, University of Delaware, Newark, DE 19716, USA.
Structured Abstract
BACKGROUND
Earth’s soil has formed by processes that have maintained a persistent and expansive global soil mantle, one that in turn provided the stage for the evolution of the vast diversity of life on land. The underlying stability of soil systems is controlled by their inherent balance between inputs and losses of nutrients and carbon. Human exploitation of these soil resources, beginning a few thousand years ago, allowed agriculture to become an enormous success. The vastness of the planet and its soil resources allowed agriculture to expand, with growing populations, or to move, when soil resources were depleted. However, the practice of farming greatly accelerated rates of erosion relative to soil production, and soil has been and continues to be lost at rates that are orders of magnitude greater than mechanisms that replenish soil. Additionally, agricultural practices greatly altered natural soil carbon balances and feedbacks. Cultivation thus began an ongoing slow ignition of Earth’s largest surficial reservoir of carbon—one that, when combined with the anthropogenic warming of many biomes, is capable of driving large positive feedbacks that will further increase the accumulation of atmospheric greenhouse gases and exacerbate associated climate change.
ADVANCES
The study of soil is now the domain of diverse schools of physical and biological science. Rapid advances in empirical and theoretical understanding of soil processes are occurring. These advances have brought an international, and global, perspective to the study of soil processes and focused the implications of soil stewardship for societal well-being. Major advances in the past decade include our first quantitative understanding of the natural rates of soil production, derived from isotopic methods developed by collaboration of geochemists and geomorphologists. Proliferation of research by soil and ecological scientists in the northern latitudes continues to illuminate and improve estimates of the magnitude of soil carbon storage in these regions and its sensitivity and response to warming. The role of soil processes in global carbon and climate models is entering a period of growing attention and increasing maturity. These activities in turn reveal the severity of soil-related issues at stake for the remainder of this century—the need to rapidly regain a balance to the physical and biological processes that drive and maintain soil properties, and the societal implications that will result if we do not.
OUTLOOK
Both great challenges and opportunities exist in regards to maintaining soil’s role in food, climate, and human security. Erosion continues to exceed natural rates of soil renewal even in highly developed countries. The recent focus by economists and natural scientists on potential future shortages of phosphorus fertilizer offers opportunities for novel partnerships to develop efficient methods of nutrient recycling and redistribution systems in urban settings. Possibly the most challenging issues will be to better understand the magnitude of global soil carbon feedbacks to climate change and to mitigating climate change in a timely fashion. The net results of human impacts on soil resources this century will be global in scale and will have direct impacts on human security for centuries to come.

The Sentinel

Human Rights Action :: Humanitarian Response :: Health ::
Holistic Development :: Sustainable Resilience
__________________________________________________
Week ending 2 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 2 May 2015

blog edition: comprised of the 35+ entries to be posted below on 3 May 2015