Tag Archives: #malaria

Malaria in the Little Novels of Sicily, and why we need literature in medicine

“And you feel you could touch it with your hand – as if it smoked up from the fat earth, there, everywhere, round about the Read More

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Malaria Outbreak Northern Cameroon

In the wake of a disaster a lot of people talk about resilience, the resilience to survive and move on, to overcome. But this notion Read More

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VOA’s news programme, Africa 54, Minister of Health Agnes Binagwaho’s interview

Health Agnes Binagwaho discusses how 
Rwanda managed to lower its rates of deaths and new

infections of HIV, TB, and malaria in the
past 10 years at the cost of $55 per person per year.

Her interview starts at the 16:20 mark.

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Congratulations, Dr. Mark Dybul

I am delighted to share that US Ambassador Mark Dybul, former leader of the US President’s Emergency Plan for AIDS Relief (PEPFAR), has been announced as the next Executive Director of the Global Fund to Fight AIDS, Tuberculosis, and Malaria. Mark is an inspiring choice by the Global Fund’s Board of Directors. I have believed in his candidacy for this position since the outset, and have great faith in what he can bring to one of global health’s most vital institutions.
Mark has long understood that global health must fundamentally be about equity and the fulfillment of the human right to health – not simply about addressing infectious diseases in far-off places. During his work to launch and expand PEPFAR, he demonstrated time and again that he believes in a person-centered approach to health care delivery and that he knows how to build strong systems that do not leave any among the most vulnerable out of benefits. Mark’s leadership in the global HIV/AIDS response helped to set a new paradigm for global health partnership, transitioning the world towards a long-term approach to tackling the most deadly pandemic in centuries while strengthening systems that have increased access to primary and specialty care for a wide range of diseases.
I am hopeful that Mark’s appointment to lead the Global Fund will help to usher in a new era of results-oriented programming that builds on the legacy of his predecessors, Michel Kazatchkine and Gabriel Jaramillo, while ensuring that the Fund stays true to its roots as an instrument truly of the people. I look forward to fruitful future collaborations with Mark and the Global Fund, and believe that the time for an integrated, solidarity-driven, and country-owned response to global health challenges is within our grasp. There is much work ahead, but the future is bright. Congratulations, Mark!

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Country Ownership to Strengthen Synergies Between Global Health Initiatives and Health Systems

On Thursday, 8 November, colleagues in the Ministry of Health and I published a brief Comment in Journal of the Royal Society of Medicine: Short Reports responding to a review of interactions between global health initiatives (like the Global Fund and PEPFAR) and country health systems. We shared Rwanda’s perspective on the importance of true country ownership in promoting integration and maximizing synergies.

Country Ownership to Strengthen Synergies Between Global Health Initiatives and Health SystemsAgnes Binagwaho, Sabin Nsanzimana, Corine Karema, Michel Gasana, Claire M. Wagner, and Cameron T. Nutt
As policymakers and researchers in Rwanda’s health sector, we applaud Josip Car and colleagues’ review of interactions between Global Fund investment and country health systems.1 Their trenchant analysis may not close the door on confidently advanced claims about the dangers of global health initiatives that are not based upon rigorous evidence, but it has helped to raise the bar for the debate.Several recent studies focused on Rwanda (that either did not fall within Car et al.’s timeframe or did not specifically investigate Global Fund programs and were thus not included in the review) together provide robust support for the argument that interventions explicitly designed to combat HIV/AIDS, tuberculosis, and malaria can be implemented in such a way as to strengthen the overall health system.2-4
In fact, Rwanda’s reductions of greater than 75% in mortality due to AIDS and tuberculosis between 2000 and 2010 were accompanied by a 70% decline in child mortality and a 60% decline in maternal mortality over the same timeframe.5 This was not a fortunate accident, but due to collaborative planning with civil society and development partners, and true country ownership of program implementation and evaluation.
From the beginning of Rwanda’s AIDS response, the public sector has been committed to constructing platforms of care able to address multiple chronic and acute conditions. When a clinic is built and staffed to offer HIV services to women, the same woman trying to prevent vertical HIV transmission to her unborn child will also require a safe place to deliver as well as a trained birth attendant. So will her neighbors, whether HIV- positive or not.
As is often said in the Ministry of Health, “if you give Rwanda money to help the youngest child born today, we will ensure that it also helps the oldest person by tomorrow.” When implemented according to principles of authentic partnership and when investing in public infrastructure and human resources, disease-specific global health initiatives can not only achieve positive spillover effects, but can also catalyze the development of comprehensive and equitable primary care systems in the poorest countries.The time has come for scholars and policymakers to move past unfounded worries about whether to invest in the pandemics of AIDS, tuberculosis, and malaria; what we must now devote our full attention to is the question of how best to harness synergies and maximize impact in the pursuit of health as a human right.

References 1 Car J, Paljarvi T, Car M, Kazeem A, Majeed A, Atun R. Negative health system effects of Global Fund’s investments in AIDS, tuberculosis and malaria from 2002 to 2009: systematic review. J R Soc Med Sh Rep 2012;3:70. 2 Price J, Leslie JA, Welsh M, Binagwaho A. Integrating HIV clinical services into primary health care in Rwanda: a measure of quantitative effects. AIDS Care 2009;21:608-614. 3 Kalk A, Groos N, Karasi JC, Girrbach E. Health systems strengthening through insurance subsidies: the GFATM experience in Rwanda. Trop Med Int Health 2010;15:94-97. 4 Shephard D, Zeng W, Amico P, Rwiyereka AK, Avila-Figueroa. A controlled study of funding for Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome as resource capacity building in the health system in Rwanda. Am J Trop Med Hyg 2012;86:902-907. 5 WHO: World Health Statistics 2012. World Health Organization, Geneva 2012.

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