External challenges to health systems, such as those caused by global economic, social and environmental changes, have received little attention in recent debates on health systems’ performance in low-and middle-income countries (LMICs). One such challenge in coming years will be increasing prices for petroleum-based products as production from conventional petroleum reserves peaks and demand steadily increases in rapidly-growing LMICs. Health systems are significant consumers of fossil fuels in the form of petroleum-based medical supplies; transportation of goods, personnel and patients; and fuel for lighting, heating, cooling and medical equipment. Long-term increases in petroleum prices in the global market will have potentially devastating effects on health sectors in LMICs who already struggle to deliver services to remote parts of their catchment areas. The authors propose the concept of “localization,” originating in the environmental sustainability literature, as one element of response to these challenges. Localization assigns people at the local level a greater role in the production of goods and services, thereby decreasing reliance on fossil fuels and other external inputs. Effective localization will require changes to governance structures within the health sector in LMICs, empowering local communities to participate in their own health in ways that have remained elusive since this goal was first put forth in the Alma-Ata Declaration on Primary Health Care in 1978. Experiences with decentralization policies in the decades following Alma-Ata offer lessons on defining roles and responsibilities, building capacity at the local level, and designing appropriate policies to target inequities, all of which can guide health systems to adapt to a changing environmental and energy landscape.
Health equity in economic and trade policies
President of the United Republic of Tanzania, John Magufuli has met with Prof John Thornton, Chairman of Barrick Gold Canada, parent company of Acacia Mining to discuss the issue of mineral sand exportation in Tanzania. The new development came after Dr Magufuli received two reports on the exportation of mineral concentrates abroad for smelting. The first committee probed at the technical aspects of the concentrate and the second committee examined the economic and legal frameworks around the export. Both reports damned Acacia for foul play and suggested that Tanzania lost over Sh100 trillion since it started exporting concentrates in the late 1990s. Dr Magufuli who was accompanied by the Minister for Legal and Constitutional Affairs Prof Palamagamba Kabuki said the meeting was successful and Barrick have “repented” for what has happened and they are ready to compensate Tanzania for the loss that has been incurred over the years. Dr Magufuli announced on a video clip tweeted on the official government spokesperson account that Barrick have “repented” and are ready to compensate Tanzania for the loss incurred over the years. Garrick Gold Canada is the largest shareholder of the Acacia Mining Company. On March 2017, the export of mineral concentrates by Barrick from Tanzania was stopped by Presidential directive.
The authors report that the world’s poorest countries are losing billions of potential tax revenue each year as a result of illicit financial flows and the tax dodging schemes associated with them. These complex and shadowy tax dealings are robbing developing countries of revenue they need to spend on essential public services. Making a Killing analyses one part of the web of illicit financial flows, the ‘misinvoicing’ of international trade – a way of hiding the true value of imports and exports, shifting profits and evading taxes. The figures are staggering. The sums being lost are comparable to the amounts currently missing from the health budgets of very poor countries – lost money that could boost total budgets and pay for desperately needed doctors, nurses, clinics, hospitals and medicines, and provide the basic minimum of decent healthcare to mothers and children. If the world is to meet its ambitious targets on health and child survival, let alone the broader objectives of the Sustainable Development Goals, illicit financial flows must be urgently addressed. This reports sets out recommendations for action by the international community.
Since 2000, the Uganda Law Reform Commission has been spearheading the process of reforming Uganda’s patent legislation. The reform is taking place in the context of the Doha Development Agenda, a process for continued negotiations on areas of concern within the WTO agreements raised by developing countries during the Fourth Ministerial Conference in Doha, Qatar in November 2001. Although the country's draft bill has been improved in a number of aspects, there is still need for improvement on the drafting language to make use of the flexibilities in the widest allowable sense and capture the new thinking regarding these flexibilities.
The importance of the pharmaceutical industry in Sub-Saharan Africa, its claim to policy priority, is rooted in the vast unmet health needs of the sub-continent. Making Medicines in Africa is an open access online book that is a collective endeavour, by a group of contributors with a strong African and more broadly Southern presence, to find ways to link technological development, investment and industrial growth in pharmaceuticals to improve access to essential good quality medicines, as part of moving towards universal access to competent health care in Africa. The authors aim to shift the emphasis in international debate and initiatives towards sustained Africa-based and African-led initiatives to tackle this huge challenge. The authors argue that without the technological, industrial, intellectual, organisational and research-related capabilities associated with competent pharmaceutical production, and without policies that pull the industrial sectors towards serving local health needs, the African sub-continent cannot generate the resources to tackle its populations' needs and demands.
The importance of the pharmaceutical industry in Sub-Saharan Africa, its claim to policy priority, is rooted in the vast unmet health needs of the sub-continent. Making Medicines in Africa, an open access book under a CC-BY license, is a collective endeavour by a group of contributors with a strong African and more broadly Southern presence, to find ways to link technological development, investment and industrial growth in pharmaceuticals to improve access to essential good quality medicines, as part of moving towards universal access to competent health care in Africa. The authors aim to shift the emphasis in the international debate and initiatives towards sustained Africa-based and African-led initiatives to tackle this huge challenge. The authors argue that without the technological, industrial, intellectual, organisational and research-related capabilities associated with competent pharmaceutical production, and without policies that pull the industrial sectors towards serving local health needs, the African sub-continent cannot generate the resources to tackle its populations' needs and demands.
Any renegotiation of the economic partnership agreements (EPAs) already initialled with the countries of Africa, the Caribbean and the Pacific (ACP) would be a disaster, Trade Commissioner Peter Mandelson told members of the EP International Trade Committee on Thursday. Referring to recurrent criticisms of the EPAs, Mr Mandelson ruled out "any suggestion of renegotiating the agreements already initialled". Any renegotiation would constitute "a new threat of legal uncertainty to the agreements but would also be a disaster for the ACP countries", according to Mr Mandelson, who restated his goal of concluding "full EPAs with comprehensive regional coverage" in the six geographical regions.
According to this study, the rate of increase in consumption of ‘unhealthy commodities’ - namely soft drinks, processed foods, tobacco and alcohol - is fastest in low- and middle-income countries (LMICs), with little or no further growth expected in high-income countries (HICs). The pace at which consumption is rising in LMICs is even faster than has occurred historically in HICs thanks to multinational companies, which have now achieved a level of penetration of food markets in middle-income countries similar to what they have achieved in HICs. Higher intake of unhealthy foods correlates strongly with higher tobacco and alcohol sales, suggesting a set of common tactics by industries producing unhealthy commodities, the authors argue. Contrary to findings from studies undertaken several decades ago, urbanisation no longer seems to be a strong risk factor for greater consumption of risky commodities at the population level, with the exception of soft drinks. Rising income has been strongly associated with higher consumption of unhealthy commodities within countries and over time, but mainly when there are high foreign direct investment and free-trade agreements. Economic growth does not inevitably lead to higher unhealthy-commodity consumption.
We are pleased that a paediatrician of the stature of Professor Oliver Ransome supports the argument in our letter that equitable distribution of health care is necessary for child health. But Professor Ransome also suggests that equitable distribution of health care can somehow be achieved without impinging on the freedom of those who can afford to choose private care. We challenge the view that such a market-based approach can promote equity in health care in South Africa today.
This report provides updated information on the status of implementing the International Code of Marketing of Breast-milk Substitutes and subsequent relevant World Health Assembly resolutions (“the Code”) in and by countries. It presents the legal status of the Code, including - where such information is available - to what extent Code provisions have been incorporated in national legal measures. The report also provides information on the efforts made by countries to monitor and enforce the Code through the establishment of formal mechanisms. Its findings and subsequent recommendations aim to improve the understanding of how countries are implementing the Code, what challenges they face in doing so, and where the focus must be on further efforts to assist them in more effective Code implementation.