Governance – Corruption

Global Corruption Barometer – Africa 2019 – CITIZENS’ VIEWS AND EXPERIENCES OF CORRUPTION
The 10th edition of the Global Corruption Barometer (GCB) – Africa, reveals that while most people in Africa feel corruption increased in their country, a majority also feel optimistic that they, as citizens, can make a difference in the fight against corruption.
Transparency International 2019 :: 68 pages
PDF: https://www.transparency.org/files/content/pages/2019_GCB_Africa.pdf

Key Findings
01 Corruption is on the rise
More than half (55 per cent) of all citizens think that corruption increased in the previous 12
months. Only 23 per cent think it declined.

02 Many governments are failing to do enough
Only one in three citizens (34 per cent) thinks their government is doing a good job at fighting corruption, while 59 per cent rate their government’s performance as bad.

03 Concerns about the integrity of public officials remain high
Among key public institutions, police are most widely seen as corrupt: 47 per cent of people say most or all police are corrupt. But also almost four in 10 citizens think most or all government officials (39 per cent) and parliamentarians (36 per cent) are corrupt. These results are consistent with the last
round of findings in 2015, where citizens similarly thought that the police were the most corrupt institution.

04 Bribery demands are a regular occurrence for many
More than one in four citizens who accessed public services, such as health care and education, paid a bribe in the previous year. This is equivalent to approximately 130 million people.

05 People’s experience with bribery varies
Men are slightly more likely to pay a bribe than women, the poorest people are twice as likely to pay a bribe as the richest people, and young people aged 18-34 are more likely to pay a bribe than people
aged 55 and over.

06 Despite fears of retaliation, citizens can make a difference
Two-thirds of citizens fear retaliation if they report corruption. Yet, despite this, more than half of citizens surveyed (53 per cent) think ordinary people can make a difference in the fight against corruption…

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Press Release
One in four people in Africa pay bribes to access services, survey says
Corruption disproportionately affects the poor and young
11 Jul 2019 Issued by Transparency International Secretariat

The tenth edition of Global Corruption Barometer (GCB) – Africa, released on African Anti-Corruption Day by Transparency International in partnership with Afrobarometer, reveals that more than half of all citizens surveyed in 35 African countries think corruption is getting worse in their country. Fifty-nine per cent of people think their government is doing badly at tackling corruption.
The largest and most detailed survey of citizens’ views on bribery and other forms of corruption in Africa, the survey asked 47,000 citizens in 35 countries about their perceptions of corruption and direct experiences of bribery.

The results show more than 1 in 4 people who accessed public services, such as health care and education, paid a bribe in the previous year. This is equivalent to approximately 130 million people.
The report also highlights that corruption disproportionately affects the most vulnerable, with the poorest paying bribes twice as often as the richest. Young people pay more bribes than those over 55 years old.

“Corruption is hindering Africa’s economic, political and social development. It is a major barrier to economic growth, good governance and basic freedoms, like freedom of speech or citizens’ right to hold governments to account,” said Patricia Moreira, Managing Director of Transparency International. “While governments have a long way to go in regaining citizens’ trust and reducing corruption, these things don’t exist in a vacuum. Foreign bribery and money laundering divert critical resources away from public services, and ordinary citizens suffer most.”…

Featured Journal Content

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 13 Jul 2019)
Viewpoints
Globalists versus nationalists: Bridging the divide through blue marble health
Peter J. Hotez
| published 11 Jul 2019 PLOS Neglected Tropical Diseases
https://doi.org/10.1371/journal.pntd.0007156

With the launch of the United Nations Millennium Development Goals (MDGs) in the year 2000, and later continuing through the 17 Sustainable Development Goals (SDGs) begun in 2016, we have been living in a time of globalism, marked by unprecedented levels of overseas development assistance from wealthy nations, especially the group of seven (G7) nations. A key element of both the MDGs and SDGs is health, with the recognition that poor health represents a major driver of poverty because of its disproportionate impact on economic productivity, child development, and the vitality and security of girls and women. Therefore, perhaps the biggest impact of this 21st century globalism has been the rise of a new era of global health, marked by the creation of new institutions such as the Bill & Melinda Gates Foundation, Gavi, and the Vaccine Alliance and an unprecedented level of financial support to provide access to essential medicines and preventive measures for HIV/AIDS, tuberculosis, and malaria through the Global Fund to Fight AIDS, Tuberculosis, and Malaria; the United States President’s Emergency Plan for AIDS Relief (PEPFAR); and the US President’s Malaria Initiative (PMI). There has also been substantial US government assistance for neglected tropical diseases (NTDs) through the US Agency for International Development (USAID) NTD Program and its United Kingdom counterpart, the Department for International Development (DFID), so that now more than 1 billion people receive treatment annually with a “rapid impact” package of medicines [1, 2].

But as we enter the third decade of this new century, we have also seen the rise of a new nationalism in a number of large and important countries and populations [3, 4]. The most notable example perhaps is the 2016 election of President Donald Trump, whose Make America Great Again initiatives focus on economic protectionism and a transactional foreign policy that emphasizes immediate gains. The US is not alone in its pivot to nationalistic activities and conservatism. The Brazilian government, led by newly elected Jair Bolsonaro, vows to be tough on crime while loosening environmental protections and placing former military leaders in key leadership positions [5]. Similarly, in Europe, we’re seeing new nationalist regimes ascend in Italy and Hungary and in a post-Brexit England, while Steve Bannon, President Trump’s former America First advisor, is regrouping nationalist parties in several countries on the European continent [3]. Globalist–nationalist divides are also deepening across Asia and Africa, in Indonesia, Thailand, and South Africa, and elsewhere [3].

A concern is that these new nationalist trends could curtail or halt the expansions in global health that we have witnessed over the previous 2 decades. Ultimately, there is a fear that retreating from globalism might go hand in hand with abandoning the United Nations Global Goals for health and international development.

However, in a series of articles published in PLOS Neglected Tropical Disease, PLOS Medicine, and elsewhere [6–10], and later in a single-author book [11], I have highlighted a new global health trend, which could still resonate with nationalist regimes. The concept “blue marble health” refers to my findings that most of the world’s poverty-related neglected diseases, including the NTDs and the “big three” diseases—HIV/AIDS, tuberculosis, and malaria—are in fact most widely prevalent in the group of 20 (G20) economies [6–11]. Specifically, these diseases predominate among the poor living in impoverished areas located near and amid wealth. Such individuals are sometimes also referred to as the “poorest of the rich” [12].

As many of the G20 nations, including the US, Brazil, Indonesia, and the European countries, grow their nationalist movements, it’s worth highlighting the fact that their poorest populations now account for most of the world’s poverty-related neglected diseases. The fact that neglected diseases represent significant drains on national economies and actually have been shown to promote poverty [1] suggests that their control or elimination should become priorities for government leaders and stakeholders. Indeed, one of the most cost-effective means to accelerate G20 economies would be through NTD control and elimination [11]. Because the G20 gross domestic products (GDPs) constitute most of the global economy, neglected disease reductions could become the most straightforward way to promote global economic development.

Could blue marble health become an important theme to mediate the differences between the globalists and nationalists (Fig 1)?

Clearly, the G20 nations, even under nationalist regimes, might benefit from blue marble health policies. However, this can occur only if nationalism does not drive up disease because of political destabilization, emigration, and loss of potential markets due to negative economic consequences.

It’s also critical that nationalism among the G20 nations does not ignore the rest of the world. What about the remaining deeply impoverished and often conflict-ridden nations at the bottom? The fact that roughly two-thirds of the world’s neglected diseases occur among the G20 [11] must not become an excuse to restrict neglected disease elimination efforts exclusively to the enlightened self-interests of nationalist regimes in a new world order. Control of the NTDs and big three diseases in Africa and the poorest countries of Asia still depends heavily on overseas development assistance through mechanisms of USAID; DFID; PEPFAR; PMI; and The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM). Therefore, advancing global health advocacy and policies will need to proceed on two fronts: continuing current assistance activities for the world’s poorest nations while expanding the blue marble health concept among the G20.

G20 outreach and blue marble health also extends to the research and development (R&D) agenda for new drugs, diagnostics, vaccines, and vector control technologies [11]. Currently, the overwhelming global health R&D expenditures arise from the US, UK, and a handful of European nations together with some newer activities through the Japanese Global Health Innovation Technology (GHIT) and Korean Research in Global Health Technology (RIGHT) funds. Accelerating global health R&D expenditures to include the underachievers in this area, such as Brazil, Russia, India, China, and South Africa (the BRICS) is also fundamental to addressing blue marble health.

There are worries that the current nationalist and neoconservative movements could undermine the global health initiatives and outreach that have served us so well since 2000. Blue marble health could become an important health policy framework to mediate the new globalist–nationalist divides.
[References at title link above]

Emergencies

POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 10 July 2019
:: A circulating vaccine-derived poliovirus type 2 (cVDPV2) has been confirmed in China. It is genetically linked to a VDPV2 isolated from an environmental sample from Xinjiang province, collected on 18 April 2018.  WHO is continuing to evaluate the situation and stands ready to support the ongoing investigation and risk assessment by national authorities.

Summary of new viruses this week:
:: Pakistan — nine wild poliovirus type 1 (WPV1) cases and 3 WPV1-positive environmental samples;
:: Angola —  one circulating vaccine-derived poliovirus  (cVDPV2) case;
:: China – one cVDPV2 case. See country sections below for more details.

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Editor’s Note:
WHO has posted a refreshed emergencies page which presents an updated listing of Grade 3,2,1 emergencies as below.
WHO Grade 3 Emergencies [to 13 Jul 2019]

Democratic Republic of the Congo
:: 49: Situation report on the Ebola outbreak in North Kivu 9 July 2019
:: Disease Outbreak News (DONs} Ebola virus disease – Democratic Republic of the Congo
11 July 2019
[See DRC Ebola+ above for detail]

Yemen
:: Outbreak update – Cholera in Yemen, 30 June 2019
8 July 2019 – The Ministry of Public Health and Population of Yemen reported 21,865 suspected cases of cholera with 13 associated deaths during epidemiological week 26 (24 to 30 June) of 2019. Thirteen percent of cases were severe. The cumulative total number of suspected cholera cases from 1 January 2018 to 30 June 2019 is 823,221, with 1210 associated deaths (CFR 0.13%). Children under five represent 23.0% of total suspected cases during 2019. The outbreak has affected 22 of 23 governorates and 299 of 333 districts in Yemen…

Nigeria
:: Nigeria intensifies cross border immunization, with special focus on nomadic populations 
Kano, 8 July, 2019 – In renewed efforts to vaccinate children traversing in and out of Nigeria, the World Health Organization (WHO) is supporting the government in an initiative to improve supplemental and routine immunization activities in the North Western region, which has a significant nomadic population.
Nomadic pastoralists live beyond the reach of established health care programs that are designed to serve sedentary populations. As a result, these groups are often under-immunized and out of the reach of existing disease surveillance activities.
Speaking on the intervention, Mallam Gwanda Mairakuma of Maiadua local government in Niger Republic said that, “with this intensified commitment, vaccination activities have reduced the number of complications associated with Measles infection on our children”…

Mozambique floods – No new digest announcements identified
Myanmar – No new digest announcements identified
Somalia – No new digest announcements identified
South Sudan – No new digest announcements identified
Syrian Arab Republic – No new digest announcements identified

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WHO Grade 2 Emergencies [to 13 Jul 2019]

Libya
:: Medical aid accelerated as Libya crisis intensifies 6 July 2019

MERS-CoV
:: Worldwide reduction in MERS cases and deaths since 2016 8 July 2019
The World Health Organization and colleagues from the University of Oxford, Imperial College London and Institut Pasteur* have estimated that, since 2016, 1 465 cases of Middle East Respiratory syndrome coronavirus (MERS-CoV) and between 300 and 500 deaths may have been averted due to accelerated global efforts to detect infections early and reduce transmission.
In 2012, a novel virus that had not previously been seen in humans was identified for the first time in a resident from Saudi Arabia. The virus, now known as MERS-CoV, has, as of 31 May 2019, infected more than 2 442 people worldwide. MERS-CoV is a respiratory virus that can cause severe disease and has been fatal in approximately 35% of patients to date. MERS is zoonotic and people are infected from direct or indirect contact with dromedary camels. While the virus has demonstrated limited ability to transmit between people outside of hospitals, it has repeatedly caused large scale outbreaks in health care facilities with severe health, security and economic impacts, most notably in Saudi Arabia in 2014-2016 and the Republic of Korea in 2015. The outbreak in the Republic of Korea in 2015 involved 186 cases and 38 deaths, and had an estimated economic impact of US$12 billion.
In a research letter published in the journal Emerging Infectious Diseases on 8 July 2019, the researchers analyze case-based data on laboratory-confirmed MERS-CoV infections reported to WHO since 2012…

Afghanistan – No new digest announcements identified
Bangladesh – Rakhine conflict – No new digest announcements identified
Cameroon – No new digest announcements identified
Central African Republic – No new digest announcements identified
Cyclone Idai – No new digest announcements identified
Ethiopia – No new digest announcements identified
Iran floods 2019 – No new digest announcements identified
Iraq – No new digest announcements identified
Malawi floods – No new digest announcements identified
Niger – No new digest announcements identified
occupied Palestinian territory – No new digest announcements identified
Sudan – No new digest announcements identified
Ukraine – No new digest announcements identified
Zimbabwe – No new digest announcements identified

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WHO Grade 1 Emergencies [to 13 Jul 2019]

Angola – No new digest announcements identified
Chad – No new digest announcements identified
Djibouti – No new digest announcements identified
Indonesia – Sulawesi earthquake 2018 – No new digest announcements identified
Kenya – No new digest announcements identified
Mali – No new digest announcements identified
Namibia – viral hepatitis – No new digest announcements identified
Tanzania – No new digest announcements identified

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UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 
Syrian Arab Republic
:: Syrian Arab Republic: Recent Developments in Northwestern Syria Situation Report No. 7 – as of 12 July 2019
HIGHLIGHTS
:: …Humanitarian response is ongoing with hundreds of thousands of people receiving critical assistance essential for their survival. Violence in areas directly affected by conflict is driving displacement into denselypopulated areas, putting a strain on service delivery for humanitarian actors. A joint assessment is currently being finalized that will provide an overview of needs in the most affected areas.
:: Civilian infrastructure, including humanitarian facilities, continues to be damaged or destroyed in the violence. In the last two weeks, at least four medical facilities have been impacted by the violence, with several other unconfirmed reports, as well as a water station serving over 80,000 people, and several schools, IDP settlements, markets and bakeries.

Yemen – No new digest announcements identified

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UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.
Editor’s Note:
Ebola in the DRC has bene added as a OCHA “Corporate Emergency” this week:
CYCLONE IDAI and Kenneth
:: Southern Africa: Cyclones Idai and Kenneth Snapshot, as of 10 July 2019.

EBOLA OUTBREAK IN THE DRC – No new digest announcements identified

The Sentinel

Human Rights Action :: Humanitarian Response :: Health :: Education :: Heritage Stewardship ::
Sustainable Development
__________________________________________________
Week ending 6 July 2019

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
GE2P2 Global Foundation – Governance, Evidence, Ethics, Policy, Practice
david.r.curry@ge2p2center.net

PDF-The Sentinel_ period ending 6 Jul 2019

Contents
:: Week in Review  [See selected posts just below]
:: Key Agency/IGO/Governments Watch – Selected Updates from 30+ entities   [see PDF]
:: INGO/Consortia/Joint Initiatives Watch – Media Releases, Major Initiatives, Research:: Foundation/Major Donor Watch -Selected Updates
:: Journal Watch – Key articles and abstracts from 100+ peer-reviewed journals  [see PDF]

Libya

Secretary-General Condemns Killing of Migrants, Refugees in Libya Air Strikes, Noting United Nations Gave Warring Parties Detention Centre’s Coordinates
3 July 2019 SG/SM/19652
The following statement was issued today by the Spokesman for UN Secretary-General António Guterres:

The Secretary-General is outraged by reports that at least 44 migrants and refugees, including women and children, have been killed and more than 130 injured following air strikes at the Tajoura migrant detention centre, east of Tripoli. He condemns this horrendous incident in the strongest terms. He expresses his deepest condolences to the families of the victims and wishes a quick recovery to those injured.

The Secretary-General calls for an independent investigation of the circumstances of this incident, to ensure that the perpetrators are brought to justice, noting that the United Nations had provided exact coordinates of the detention centre to the parties. The Secretary-General further reminds all parties of their obligations under international humanitarian law to take all feasible precautions to avoid, and in any event to minimize, incidental loss of civilian life, injury to civilians and damage to civilian objects, and to refrain from directing attacks against civilians. This incident underscores the urgency to provide all refugees and migrants with safe shelter until their asylum claims can be processed or they can be safely repatriated.

The Secretary-General reiterates his call for an immediate ceasefire in Libya and a return to political dialogue.

Poverty – Development

The Poverty Alleviation Coalition
In 2019 an unprecedented 71.4 million people worldwide have been forced from their homes. To compound matters, 85% of 25.1 million refugees globally are hosted in developing countries. 25% live in the least developed countries. Here, refugees and host communities alike often find themselves enduring extreme poverty and scarce economic opportunities. Further, the majority of refugees worldwide live in protracted situations for five years or more, making most refugees less suited for emergency relief than for longer term solutions.

With an average of 30 persons being forcibly displaced every minute of every day, both refugees, nationals in host communities, and host country governments experience increasing social and economic pressure. In addition to new and protracted conflicts, climate change impacts will significantly add to the numbers of the forcibly displaced in coming years. Refugees and nationals in host communities are often forced into informal employment without regular earnings and social protection, thus, leaving many with little resilience to shocks and highly dependent on humanitarian aid. In locations where the level of poverty of refugees and host communities is on par, disparities in access to relief, resources and infrastructure often create pressure on refugees and nationals alike. This in turn puts fiscal and political pressures on hosting governments and social services, particularly in low-income countries.

Enabling refugees to work in their host country has received renewed attention in the past years as a way to combine development needs of host communities and countries with the humanitarian needs of refugees. When refugees are able to work, their self-reliance is enhanced, and they are able to provide for themselves and their families, increase resilience, regain dignity, and build independent and meaningful future. Ultimately, access to livelihoods and jobs enables the impoverished to meet their needs for protection, food security, health, housing, and other essential services in a safe, sustainable, and dignified manner. A growing body of evidence suggests that including refugees in local economies contributes to economic growth, and can thus be mutually beneficial for refugees and host communities. Overall, access to work reduces pressure on refugees and hosts locally, contributes to economic growth, and therefore eases pressure on the host country as a whole.

In December 2018 the United Nations adopted the Global Compact on Refugees (GCR) in which member states committed to the objectives of reducing pressure on host countries and enhancing refugee self-reliance. This is to be achieved by increased international burden and responsibility sharing, and by mobilizing the international community and stakeholders as a whole. In line with the 2030 Agenda’s Sustainable Development Goals, the Compact calls for alleviating poverty which is itself a significant root cause of large refugee populations.

In response to the global poverty situation among refugees and nationals in host communities, and in line with the GCR spirit, a coalition between the UNHCR, The World Bank Partnership for Economic Inclusion (PEI) and 11 NGOs has been formed with the goal of alleviating poverty for refugees and host communities in selected countries.

The partners are:
World Vision
Mercy Corps
Concern Worldwide
BOMA Project
Caritas Suisse
GOAL
BRAC
HIAS
Trickle Up
Village Enterprise
Norwegian Refugee Council (NRC).

,

The Poverty Alleviation Coalition
Vision
A coalition of UNHCR, The World Bank Partnership for Economic Inclusion (PEI) and 11 NGOs will work towards the common vision of increasing self-reliance, economic and social inclusion of refugees & host communities by sustainably increasing income-earning opportunities.

500,000 households
Alleviating poverty of half a million households consisting of refugees and host communities as an objective within 5 years. The Coalition will run two cohorts from 2020-2025. This is a direct response to the high levels of poverty among refugees and host communities in low income countries.

The Graduation Approach
The Graduation Approach will guide the coalition’s response. The approach combines humanitarian and development assistance and helps the extremely poor refugees and host communities to become self-reliant. The methodology is developed by BRAC and show impressive results with 95% of participants graduating out of poverty. A programme is typically 18-36 months.

35 countries
The Coalition has a target of reaching 35 countries across Africa, Asia, Europe and Latin America from 2020-2025. Target households are in areas where both refugees and nationals live in poverty and close proximity. Fundraising is ongoing.

Parallel funding
Parallel funding where donors fund implementing NGOs directly is the Coalition’s modality. UNHCR and PEI will be the main conveners by facilitating access to populations, supporting programming and fundraising, as well as monitoring and evaluation of the Coalition’s programmes.

US$ 1,400/household
The approximate cost of alleviating a household of extreme poverty is on average US$ 1,400. To meet the coalition’s goal of alleviating 500,000 households, the annual need is an average of USD 140 million annually for 5 years (totaling US$ 700 million).

SDGs – Health Financing

High-Performance Health-Financing for Universal Health Coverage: Driving Sustainable, Inclusive Growth in the 21st Century
World Bank
Publication June 27, 2019 :: 82 pages
PDF: http://documents.worldbank.org/curated/en/641451561043585615/
Overview
Just over a decade out from the SDG deadline of 2030, many developing countries are not on track to meet Universal Health Coverage (UHC) targets to ensure access to quality, affordable health services to all. People in developing countries pay over half a trillion dollars annually out-of-pocket for health services, which is pushing about 100 million people into extreme poverty each year. The evidence is strong that progress towards UHC would spur not just better health but also inclusive and sustainable economic growth, yet this report estimates that in 2030 there will be a UHC financing gap of $176 billion in the 54 poorest countries. This threatens decades-long progress on health, endangers countries’ long-term economic prospects, and makes them more vulnerable to pandemic risks. This report, launched to inform the first-ever G20 Finance and Health Ministers session in Osaka, Japan in June 2019, lays out an action agenda for countries and development partners to bridge the UHC financing gap, and makes a strong case for a focus on innovation in health financing over the next decade.

Education

World Bank, UNESCO Institute for Statistics Join Forces to Help Countries Measure Student Learning
PARIS July 4, 2019 – The World Bank and UNESCO Institute for Statistics (UIS) today announced a new partnership to help countries strengthen their learning assessment systems, better monitor what students are learning in internationally-comparable ways and improve the breadth and quality of global data on education.

This partnership is part of a collaborative effort to tackle the global learning crisis marked by the slowdown in the improvement of access to education in recent years – leaving over 262 million children, adolescents and youth out of school— and hundreds of millions who are in school but not learning enough.

“Over half of the world’s children cannot read and understand a simple story by the age of 10 – this is unacceptable. Reading and numeracy are rights and must be tackled, urgently, to ensure children can develop the fundamental skills necessary for building the strong and resilient economies of the future,” said Jaime Saavedra, World Bank Global Director for Education. “Many countries do not undertake the systematic measurement of learning needed to track progress and inform education policies. Without this data, policymakers are flying blind. This partnership will help ensure that countries have the right tools to measure learning and to close the data gaps underpinning the global learning crisis,” said Saavedra.

“Our focus is on supporting developing countries to strengthen their national assessments and on working with other international partners and countries to generate the necessary consensus to produce the best education statistics necessary for an evidence-based policymaking process,” said Stefania Giannini, Assistant Director-General for Education of UNESCO. “This partnership will allow us to collaborate on supporting countries with the tools and technical support they need to track progress towards the Sustainable Development Goal 4 (SDG 4), to see what is working, what challenges remain, and where improvements can be made.”

Both the Sustainable Development Goal on inclusive, equitable and quality Education and the education-related component of the World Bank’s Human Capital Index (HCI) released last year provide an impetus for measuring learning outcomes in internationally comparable ways, and over time.

The partnership will harness key global initiatives of the two institutions to strengthen countries’ national capacity for the design, administration and analysis of large-scale national learning assessments. The UIS is leading global efforts to expand internationally comparable data on learning outcomes, leveraging countries’ national measurement efforts. The World Bank is developing a Global Education Policy Dashboard to enable countries to monitor how well their education systems are oriented toward improving learning and educational attainment for all children…

Health – Medicines Quality/Safety

WHO launches five-year plan to improve the quality and safety of health products
1 July 2019 | News release
…Despite global progress, serious problems with health product quality and safety persist, particularly in lower- and middle-income countries. These problems threaten the health of people every day and waste resources. Quality and safety of medicines, vaccines and other products are compromised when manufacturers, whether by accident or intent, produce substandard products, when the supply chain allows unsafe medical products through, and when systems (usually due to lack of resources) are too slow to respond to adverse events.

Current regulatory capacity and enforcement are insufficient in most developing countries. WHO estimates that only 3 out of 10 regulatory authorities globally function according to acceptable standards. To compound that, manufacturing of health products has become increasingly globalized, with products and the materials that go into them crossing several borders before they reach patients, requiring even greater global vigilance. And with the rise of non-communicable diseases, such as cancer, cardiovascular conditions and diabetes, regulatory authorities in developing countries are facing greater workloads and new demands to regulate innovative products.

Universal health coverage will bring about greater access to medical products, but we must ensure that those products are quality-assured, safe and effective so that they do what they are supposed to do – prevent illness and improve people’s health. That is why today’s launch of WHO’s five-year plan ‘Delivering Quality-assured Medical Products for All 2019–2023’ is important.

The plan outlines work and activities to reach four main objectives:
[1] Strengthen country and regional regulatory systems – improving the functioning of regulatory authorities but also speeding up product registration timelines so that patients can get the product sooner, and facilitating cross-border collaboration;
[2] Increase regulatory preparedness for public health emergencies – equipping regulators with the knowhow to deal with emergencies, including by fast-tracking product approval processes and improving crisis communication;
[3] Strengthen and expand WHO prequalification – WHO prequalification of priority health products has contributed to treating millions of people with quality, cost-effective HIV medicines, as well as to the vaccination of millions of children through Gavi, the Vaccine Alliance. It is now expanding to include cancer medicines as the cancer burden grows in low- and middle-income countries;
[4] Increase the impact of WHO’s Regulatory Support activities – by aligning work across all levels of the organization, with particular attention given to countries’ needs.

Providing oversight of health products throughout their lifecycle – from laboratory to health facility – is the linchpin of effective prevention, diagnosis and treatment and an essential part of WHO’s drive towards universal health coverage. While WHO has worked to improve the quality and safety of health products for many years, this is the first time we are aligning goals and activities with global partners (Bill and Melinda Gates Foundation, UNITAID, The Global Fund to Fight AIDS, TB and Malaria, GAVI and UNICEF) to ensure full coordination and work towards a common goal – to deliver a safe and quality-assured supply of medicines, vaccines, medical devices and other health products for all populations.

External assessment report of the programmes, prequalification and regulatory supporting activities
WHO makes available the outcomes of an external assessment report of the programmes, prequalification and regulatory supporting activities. The review aims to increase a fact-based understanding of the impact and value of WHO’s work on prequalification of medicines, vaccines and in-vitro diagnostics and supporting regulatory activities, including norms and standards setting, regulatory systems strengthening, safety monitoring and vigilance.

Key findings:
:: WHO Prequalification (PQ) programme enables a core market of approximately US$3.5 billion with the majority coming from vaccines
:: WHO PQ has a Return on Investment of 30-40 to 1 for the PQ-enabled donor-funded market (US$ million)
:: Most donors and procurers and implementing partners view PQ approval as equivalent to approvals by stringent regulatory authorities
:: 340-400 million more patients have access thanks to resources freed up by PQ
:: National regulatory authorities (NRAs) relying on Collaborative Registration Procedure (CRP) have achieved significant acceleration of approval timelines vs pre-CRP registrations

Impact on countries:
:: Since 1997, WHO trained more than 8’000 NRA staff worldwide and number of functional NRAs increased by 70%
:: Four types of inspection-related capacity building activities are held to support local NRAs
:: A positive correlation is observed between the number of substandard and falsified medical products reported and the number of trained focal points
:: Number of reports on adverse events in medicines has increased in regions with extensive training activities
:: Number of countries with basic vaccine safety monitoring system has increased with workshops held in the regions

Opportunities for improvement:
:: Improve external communication and operational efficiency
:: Strengthen cross-functional collaboration and communication
:: Increase cooperation with entities outside of the department, e.g. emergencies, procurement
:: Continue efforts to expand existing PQ-product list with a more end-to-end lifecycle view
:: Increase awareness of WHO support provided during the early development phase of a product

Featured Journal Content

BMC Medical Ethics
13 June 2019; 20(40)
Research Article
Mention of ethical review and informed consent in the reports of research undertaken during the armed conflict in Darfur : a systematic review
Ghaiath Hussein, Khalifa Elmusharaf
Abstract
Background
Armed conflict in Darfur, west Sudan since 2003 has led to the influx of about 100 international humanitarian UN and non-governmental organizations to help the affected population. Many of their humanitarian interventions included the collection of human personal data and/or biosamples, and these activities are often associated with ethical issues. A systematic review was conducted to assess the proportion of publicly available online reports of the research activities undertaken on humans in Darfur between 2004 and 2012 that mention obtaining ethical approval and/or informed consent.
Methods
This systematic review is based on a systematic literature search of Complex Emergency Database, ReliefWeb, PubMed), followed by a hand search for the hardcopies of the eligible reports archived in the Centre for Research on the Epidemiology of Disasters (CRED) in Brussels.
Results
The online search showed that out of the 68 eligible studies, 13.2% (9) reported gaining ethical approval and 42.6% (29) that an informed consent was obtained from the participants. The CRED search included 138 eligible reports. None of these reports mentioned gaining ethical approval and 17 (12.3%) mentioned obtaining informed consent from their participants.
Conclusions
The proportion of studies reporting ethical review and informed consent was smaller than might be expected, so we suggest five possible explanations for these findings. This review provides empirical evidence that can help in planning ethical conduct of research in humanitarian settings.

DRC – Cholera

More than a million people to be vaccinated in phase 2 of a huge cholera vaccination campaign in the Democratic Republic of the Congo
MBUJI-MAYI / GENEVA, 3 JULY 2019 — Phase 2 of the biggest ever oral vaccination campaign against cholera is scheduled to take place from 3-8 July 2019 in 15 health districts in the four central provinces of the Democratic Republic of the Congo (DRC) – Kasaï, Kasaï Oriental, Lomami et Sankuru. The second dose of vaccine confers lasting immunity against cholera, and is being targeted at 1,235,972 people over 1 year of age. The 5-day, door-to-door campaign will involve 2632 vaccinators recruited mainly from local communities, whose job it is to administer the oral cholera vaccine, fill in vaccination cards and tally sheets, and compile a daily summary of the teams’ progress.

In parallel, 583 community mobilizers have been selected – 1 mobilizer for every 3 teams in urban areas and 1 mobilizer for every 2 teams in rural districts. Their job is to alert local people that vaccinators will visit their homes. They will use loudspeakers to spread the message, particularly in the early evening. The campaign is organized by the Ministry of Health with technical, logistic and financial support from WHO, Gavi, the Vaccine Alliance and the Global Task Force on Cholera Control (GTFCC). It is the second such campaign in this central region of the DRC. 1,224,331 people over 1 year of age were vaccinated during the first round in late December 2018. The purpose of the vaccination campaign is to contain the serious epidemic which resulted in 9154 presumed cases and 458 deaths (case-fatality rate of 5%) in the 5 affected provinces in Kasaï region between January and December 2018.

This cholera vaccination campaign marks the intensification of our response in the DRC,” said Dr Matshidiso Moeti, WHO Regional Director for Africa, “WHO and our partners are working with national authorities to rollout the vaccine, which comes in addition to multiple interventions introduced since the beginning of the cholera epidemic, including sanitation and water quality control in the affected areas, many of which have little access to a safe water supply.”

Right now, with the second dose, the preventive campaign for which 1,235,972 doses of oral vaccine have been laid in will ensure coverage of all at-risk areas in this central region of the DRC. The vaccines have been provided from global cholera vaccine stocks managed by Gavi, the Vaccine Alliance. “This vaccination campaign will play a key role in bringing this cholera outbreak under control,” said Dr Seth Berkley, CEO of Gavi. “The DRC is currently going through an unprecedented combination of deadly epidemics, with Ebola and measles outbreaks also causing untold misery across the country. It is vital that the global effort to control these outbreaks continues to receive support: we cannot allow this needless suffering to continue.”…

Emergencies

POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 3 July 2019
:: G20 Leaders met on 28-29 June 2019 in Osaka, Japan, and discussed major challenges facing the world and the importance of eradicating polio. The G20 declaration states, “We reaffirm our commitment to eradicate polio as well as to end the epidemics of AIDS, tuberculosis and malaria and look forward to the success of the sixth replenishment of the Global Fund to fight AIDS, Tuberculosis, and Malaria.” Read more here.
:: A second cVDPV2 outbreak has been reported in Angola this year; the earlier outbreak was detected in Lunda Norte province; for which an outbreak response is in progress (in close coordination with DRC). The Global Polio Eradication Initiative (GPEI) Outbreak Preparedness and Response Task Team (OPRTT) is also supporting the Angola polio eradication team on planning the response to the new outbreak in Huila.
:: The World Health Organization is seeking Expressions of Interest from public- and private-sector vaccine manufacturers and other institutions on development and manufacture of affordable poliovirus virus-like-particle vaccine.  Read more here

Summary of new viruses this week:
:: Afghanistan —two wild poliovirus type 1 (WPV1)-positive environmental samples;
:: Pakistan — five WPV1 cases and 18 WPV1-positive environmental samples;
:: Nigeria — five circulating vaccine-derived poliovirus type 2 (cVDPV2)-positive environmental samples case;
:: DR Congo —  one cVDPV2 case;
:: Angola—  one cVDPV2 case and four cVDPV2 isolated from healthy community contacts.

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Editor’s Note:
WHO has posted a refreshed emergencies page which presents an updated listing of Grade 3,2,1 emergencies as below.

WHO Grade 3 Emergencies [to 6 Jul 2019]

Democratic Republic of the Congo
:: More than a million people to be vaccinated in phase 2 of a huge cholera vaccination campaign in the Democratic Republic of the Congo 3 July 2019
:: 48: Situation report on the Ebola outbreak in North Kivu 2 July 2019
:: Disease Outbreak News (DONs} Ebola virus disease – Democratic Republic of the Congo
4 July 2019
[See DRC Ebola+ above for detail]

Syrian Arab Republic
:: WHO delivers healthcare to displaced people in north-west Syrian Arab Republic
2 July 2019

Yemen
:: WHO supports emergency medical care in Al Thawra Hospital, Sana’a, Yemen
2 July 2019

Mozambique floods – No new digest announcements identified
Nigeria – No new digest announcements identified
Myanmar – No new digest announcements identified
Somalia – No new digest announcements identified
South Sudan – No new digest announcements identified

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WHO Grade 2 Emergencies [to 6 Jul 2019]

Ethiopia
:: Ethiopia sets new standards for the management of acute malnutrition 26 June 2019

Afghanistan – No new digest announcements identified
Bangladesh – Rakhine conflict – No new digest announcements identified
Cameroon – No new digest announcements identified
Central African Republic – No new digest announcements identified
Cyclone Idai – No new digest announcements identified
Iran floods 2019 – No new digest announcements identified
Iraq – No new digest announcements identified
Libya – No new digest announcements identified
Malawi floods – No new digest announcements identified
MERS-CoV – No new digest announcements identified
Niger – No new digest announcements identified
occupied Palestinian territory – No new digest announcements identified
Sudan – No new digest announcements identified
Ukraine – No new digest announcements identified
Zimbabwe – No new digest announcements identified

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WHO Grade 1 Emergencies [to 6 Jul 2019]

Angola – No new digest announcements identified
Chad – No new digest announcements identified
Djibouti – No new digest announcements identified
Indonesia – Sulawesi earthquake 2018 – No new digest announcements identified
Kenya – No new digest announcements identified
Mali – No new digest announcements identified
Namibia – viral hepatitis – No new digest announcements identified
Tanzania – No new digest announcements identified

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UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 
Syrian Arab Republic
:: Syria: Humanitarian Response in Al Hol camp, Situation Report No. 5 – As of 5 July 2019
Published on 05 Jul 2019
HIGHLIGHTS
:: The camp population is at 70,097 individuals or 19,824 households, as of 26 June; more than 90% are children and women. The decrease in numbers from 73,782 four weeks ago, is the result of updated distribution figures, a slight increase in repatriation of 3rd country nationals and the return of hundreds of internally displaced Syrians to Raqqa governorate.
:: A total of 35 humanitarian partners; UN agencies and other humanitarian organisations, are delivering a range of services and activities in the camp. Needs remain considerable across all sectors; such as in protection, health, water, sanitation and hygiene, shelter and education. Water quantity and quality, poor hygiene conditions, inadequate feeding habits and limited health services pose challenges.
:: Past month has seen a slight increase in acute malnutrition, and a sharp increase in acute diarrhea. However, overall emergency thresholds have not been breached and assistance efforts remain within SPHERE standards…
:: Humanitarian access to the annexes hosting some 11,000 foreign nationals, who are not Iraqi nor Syrian, has slightly improved although it remains restricted, particularly in the evening and during night time – and continues to impact and prevent delivery of services 24/7. More approvals are being granted to humanitarian actors to access the annexes and one INGO already has a static health center in an annex.

Yemen – No new digest announcements identified

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UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.
Editor’s Note:
Ebola in the DRC has bene added as a OCHA “Corporate Emergency” this week:
CYCLONE IDAI and Kenneth – No new digest announcements identified
EBOLA OUTBREAK IN THE DRC – No new digest announcements identified