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Working Together to Improve Global Health Chapter 16

Chapter 15: Working Together to Improve Global Health

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Cooperating to Improve Global Health

Cooperation is in everyone’s interest:

Creates consensus around a cause.

Strengthens advocacy efforts.

Allows for sharing knowledge and setting standards.

Many aspects of global health are “global public goods.”

Better surveillance.

More effective financing.

Some global health issues can only be solved through the cooperation of various actors in global health. This could include, for example, the development of an AIDS or Ebola vaccine.

It is important that global standards in some health fields be established and widely accepted. It is imperative that different actors work together globally in areas such as disease surveillance, the global fight for polio eradication, and the standards for some diseases control programs, such as TB.

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Key Actors in Global Health

Agencies of the United Nations

WHO - World Health Organization

UNICEF - United Nations Children’s Fund

UNAIDS - Joint United Nations Program on HIV/AIDS

Engaged in advocacy, generating and sharing knowledge, setting global standards and other key functions

There are many actors in global health and among the most actively involved are WHO, UNICEF, UNAIDS. These organizations are engaged in advocacy, generating and sharing knowledge, setting global standards and other key functions.

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Key Actors in Global Health

African Development Bank, the Asian Development Bank, the Inter-American Development Bank, and the World Bank

Owned by their member countries

Lend or grant money to countries to promote economic and social development

Multilateral Development Banks

There are a number of banks that lend or grant money to developing countries and economies in transition. Among them are African Development Bank, the Asian Development Bank, the Inter-American Development Bank, and the World Bank. These banks are owned by their member countries and referred as multilateral. These institutions differ from real bank in the way that they do not function to earn money through their lending opportunities; rather their main focus is to serve as financial intermediary.

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Key Actors in Global Health

USAID, Australian Agency for International Development, Canadian International Development Agency, and others

Primarily the development assistance agencies of developed countries.

Work directly with low- and middle-income countries to advance economic and social development.

Involved in advocacy, knowledge generation, financing.

Bilateral Agencies

Most high-income countries have development assistance organizations, such as USAID, AUSAID, and DFID, which also play important roles in the health sector. These organizations work directly with low- and middle-income countries to advance economic and social development and are involved in advocacy, knowledge generation, financing.

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Key Actors in Global Health

Foundations

A number of foundations are deeply involved in global health work, such as the Bill & Melinda gates Foundation and the Carter Center.

Rockefeller Foundation is a New York based foundations that seek to reduce avoidable unfair differences in the health status of the populations. This foundation was instrumental in the establishing the first schools of public health in the United States and was also deeply involved in the development of a vaccine against yellow fever.

The Carter Center which was founded and currently stationed in Atlanta, Georgia. A nonprofit public policy center founded by Jimmy and Rosalynn Carter to fight disease, hunger, poverty, conflict, and oppression around the world, which received the Nobel Peace Price in 2002. The Carter Center began spearheading the campaign to eradicate Guinea word disease.  In1986, there were about 3.5 million annual cases of the disease in 20 countries in Africa and Asia. In 2013, there were 148 reported cases in four countries. Guinea worm disease is poised to be the first parasitic disease  to be eradicated and the only disease to be eradicated without the use of vaccines or drugs. 

The Gates Foundation is based in the United States with the aim to help spread known technologies like immunization to improve health. The main areas of work for this foundation are nutrition, maternal health and family planning, neonatal and child health, infectious diseases-HIV, TB, malaria, pneumonia, neglected diseases, and diarrhea, vaccine preventable diseases, and tobacco.

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Key Actors in Global Health

Research Funders

Focus on doing and funding research.

Gates Foundation, Wellcome Trust, Howard Hughes Medical Research Institute.

US National Institute of Health, National Health and Medical Research Council of Australia, and others supported by national governments.

There are a number of organizations whose primary focus is to carry out and fund research. Gates Foundation, Wellcome Trust, Howard Hughes Medical Research Institute ,US National Institute of Health, National Health and Medical Research Council of Australia, and others supported by national governments are examples of some such organizations.

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Nongovernmental Organizations

BRAC

Currently working in several countries in Asia and Africa.

Works in areas of human rights and social empowerment, education and health, economic empowerment and enterprise development, livelihood training, environmental sustainability and disaster preparedness.

Women and children take priority.

BRAC was founded in Bangladesh in 1972. It is the largest NGO in the world involved in international development. Currently working in several countries in Asia and Africa, BRAC works in areas of human rights and social empowerment, education and health, economic empowerment and enterprise development, livelihood training, environmental sustainability and disaster preparedness. This organization gives women and children priority through a variety of approaches. They have created birthing centers for women living in slums and initiated programs to promote exclusive breastfeeding and timely introduction of complementary foods.

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Nongovernmental Organizations

Medicins Sans Frontieres/

Doctors Without Borders

Umbrella organization made up of affiliated groups in 18 countries.

Best known for provision of health services following humanitarian crises.

Commitment to political independence, medical ethics and human rights

Video: About Doctors without Borders (9:11)

https ://www.youtube.com/watch?v=73zMcdGfXGE

On the next few slides, we will be learning about some specific organizations that have been working in the area of global health tirelessly to provide emergency help and short and long term development programs.

In this video, we will learn about Doctors without Borders.

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Nongovernmental Organizations

Oxfam

Supports long-term development programs in local communities with a focus on women.

Emergency relief for natural disasters and conflict with an emphasis on clean water, sanitation and shelter.

Advocacy work on the international policy front.

Video: A beginner’s guide to land grab (2:23) http ://www.oxfam.org/en/grow/video/2012/beginners-guide-land-grabs

On this slide, we will learn about Oxfam.

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Nongovernmental Organizations

Save the Children

Seeks to contribute to individual and community self-sufficiency.

Particular attention to well-being of newborns and children, reproductive health, and HIV/AIDS.

Video: Work of Save the Children (3:26) http ://www.savethechildren.org/site/c.8rKLIXMGIpI4E/b.6146357/k.2755/What_We_Do.htm

On this slide we will learn about Save the Children.

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Nongovernmental Organizations

Advocacy Organizations

Carry out research and policy studies studies

Advocacy activities for public at large, funding agencies, national legislatures, governments

May be aligned with specific issues

Think Tanks and Universities

Often create institutes that bring researchers together to work on global health issues

Involved in teaching, research, and practice on global health issues

Technical assistance on the design, monitoring and evaluation of global health projects

Consulting Firms

For-profit and not-for-profit

Address a range of issues such as management, economics, financing, and policy

Particular areas of expertise, such as supply chain management, nutrition, behavior change communications, or social marketing

Specialized Technical Organizations

Best known example is the CDC

Assist with planning and carrying out disease surveillance

Technical assistance for disease control programs

Let us look at some other nongovernmental organizations and their activities in global health.

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Partnerships Related to WHO

Most of the resource poor countries cannot tackle these problems without aid, and no individual development partner can provide enough assistance to help deal effectively with the scale of these problems. Therefore a number of organizations have decided work together like partnerships that work closely with WHO. Examples of such partnerships are Roll Back Malaria and Stop TB.

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STOP TB

Composed of a wide array of partners with the goal of eliminating TB as a public health problem.

Roll Back Malaria

Partnership including a variety of public and private actors that promote appropriate prevention and treatment of malaria.

Other Partnerships and Special Programs

GAVI - Main aims are to improve the ability of health systems to carry out immunization, raise rates of coverage in low- and middle-income countries, and promote uptake of underused vaccines.

The Global Fund - Provides financing and engages in advocacy for HIV, TB, and malaria with a particular interest in scaling up programs for HIV antiretroviral therapy.

Global partners are considering concerns over a number of issues that affect poor. One need is to provide vaccination programs in disadvantage group. To address immunization more effectively, the Global Alliance for Vaccines and Immunizations was established. The main aims of this organization are to improve the ability of health systems to carry out immunization, raise rates of coverage in low- and middle-income countries, and promote uptake of underused vaccines. The Global Fund to fight AIDS, TB, and Malaria was also established provides financing and to engage in advocacy for HIV, TB, and malaria with a particular interest in scaling up programs for HIV antiretroviral therapy.

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Other Partnerships and Special Programs

Public-Private Partnerships

Aim is often to develop new products.

International AIDS Vaccine Initiative (IAVI)- advocates for AIDS vaccine, develops policies and programs that would encourage use of an AIDS vaccine if one were developed, engages in research and development of candidate AIDS vaccines.

As interest in global health rose in the mid-1990s, many of the actors in this field increasingly believe in the mechanism for developing, manufacturing and distributing new products. Today there is wide range of public private partnerships for health, including Aeras, Global Alliance for TB Drug Development, Human Hookworm Vaccine Institute, International AIDS Vaccine Initiative, International Partnership for Microbicides, Malaria Vaccine Initiative, and Medicines for Malaria Venture.

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Trends in Global Health Efforts

Shift to focus on building capacity for global public health efforts, health systems development, and working together to fight the burden of disease.

Family planning shift from focus on limiting family size to focus on general reproductive health.

Importance of primary care.

Greater private sector involvement.

Different countries have realized it is essential to address the health issues collectively. Hence, the shift has focused on building capacity for global public health efforts, health systems development, and working together to fight the burden of disease. Another area of shift has been seen in family planning. Family planning shift from focus on limiting family size as it was led by USA to focus on general reproductive health. The Alam Ata declaration has put emphasis on primary health care and on the health needs of the poor. The Alam Ata declaration was linked to the world’s effort to achieve what was called globally “Health for All by the year 2000”.

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Setting the Global Health Agenda

World Health Assembly of the World Health Organization.

Groups of development assistance agencies.

Increasing role in agenda setting of the Gates Foundation.

Writings and advocacy efforts of WHO, multilateral or bilateral agencies, and NGOs.

Popular action led by NGOs, often including, for example, MSF or Doctors Without Borders.

Each year ministers of health of WHO member countries meet in Geneva, Switzerland, to consider important global health matters and resolutions proclaiming their interest in and commitment to key health issues. Some of the global health development has been encouraged by writing, advocacy efforts and program activities of WHO, multilateral or bilateral agencies and some of the important NGOs involved in health. The way in which the agenda is set for specific health topics will depends on the actors who have particular interest in the topic at hand.

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Future Challenges

Cooperative surveillance, prevention and treatment of emerging or re-emerging conditions.

Working together to strengthen weak health systems.

Addressing knowledge gaps that prevent progress in preventing and treating AIDS, TB, Ebola, malaria.

Creating new public-private partnerships.

Financing important initiatives.

Continuing good leadership in the global health community.

The global health community will likely face a number of key challenges in the future. These might include, for example: filling key gaps in knowledge and encouraging public and private sector organizations to develop the diagnostics, vaccines, and drugs needed to address the most important global health issues. Other key challenges include the need for organizations to work together to strengthen health systems, to combat individual diseases, and to try to ensure that critical global health needs have adequate financing.

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