• The field is ever further: In search of the elusive space of fieldwork

      Stellmach, D (SAGE Publications, 2020-01-07)
      This short reflection considers how humanitarian workers conceptualize and practice “the field” as a site of action. Through the use of narrative ethnography, and drawing on comparisons with the practice of academic anthropology, it attempts to draw out disciplinary assumptions that govern how and where humanitarian action is undertaken. It demonstrates how the field is a central imaginary that underpins the principles and performance of both anthropology and humanitarian action. It highlights how the conceptualization of “the field” is itself a methodological tool in the practice of humanitarian intervention.
    • Fighting Poor-Quality Medicines in Low- And Middle-Income Countries: The Importance of Advocacy and Pedagogy

      Ravinetto, R; Vandenbergh, D; Macé, C; Pouget, C; Renchon, B; Rigal, J; Schiavetti, B; Caudron, JM (BioMed Central, 2016-11-10)
      The globalization of pharmaceutical production has not been accompanied by a strengthening and harmonization of the regulatory systems worldwide. Thus, the global market is characterized today by a situation of multiple standards, and patients in low- and middle-income countries are exposed to the risk of receiving poor-quality medicines. Among those who first raised the alarm on this problem, there were pioneering humanitarian groups, who were in a privileged position to witness the gap in quality of medicines between high-income countries and low- and middle-income countries. Despite an increasing awareness of the problem and the launch of some positive initiatives, the divide in pharmaceutical quality between the North and the South remains important, and insufficiently addressed. More advocacy is needed for universal access to quality-assured medicines. It should target all those who are strongly "involved" with medicines: regulators, international organizations, journalists, purchasers, prescribers, program managers, policy makers, public health actors and the patients. Advocacy should be based on evidence from research and monitoring programs, and technical concepts should be translated in lay language through communication tools that address all the stakeholders. The fight to ensure universal access to quality medicines needs the participation of all, and can only be successful if grounded in common understanding.
    • Financial access to health care in Karuzi, Burundi: a household-survey based performance evaluation.

      Lambert-Evans, Sophie; Ponsar, Frederique; Reid, Tony; Bachy, Catherine; Van Herp, Michel; Philips, Mit; Médecins Sans Frontières (Belgium), 94 rue Dupré, Brussels, Belgium. sophielambertevans@gmail.com. (2009-10-24)
      ABSTRACT: BACKGROUND: In 2003, Médecins Sans Frontières, the provincial government, and the provincial health authority began a community project to guarantee financial access to primary health care in Karuzi province, Burundi. The project used a community-based assessment to provide exemption cards for indigent households and a reduced flat fee for consultations for all other households. METHODS: An evaluation was carried out in 2005 to assess the impact of this project. Primary data collection was through a cross-sectional household survey of the catchment areas of 10 public health centres. A questionnaire was used to determine the accuracy of the community-identification method, households' access to health care, and costs of care. Household socioeconomic status was determined by reported expenditures and access to land. RESULTS: Financial access to care at the nearest health centre was ensured for 70% of the population. Of the remaining 30%, half experienced financial barriers to access and the other half chose alternative sites of care. The community-based assessment increased the number of people of the population who qualified for fee exemptions to 8.6% but many people who met the indigent criteria did not receive a card. Eighty-eight percent of the population lived under the poverty threshold. Referring to the last sickness episode, 87% of households reported having no money available and 25% risked further impoverishment because of healthcare costs even with the financial support system in place. CONCLUSION: The flat fee policy was found to reduce cost barriers for some households but, given the generalized poverty in the area, the fee still posed a significant financial burden. This report showed the limits of a programme of fee exemption for indigent households and a flat fee for others in a context of widespread poverty.
    • First round of payments from the Global Fund.

      Ellman, T; Ford, N; Brugha, R (2002-07-20)
    • French Polynesia: A Nuclear Paradise in the Pacific.

      Veeken, H; Médecins Sans Frontières Netherlands, Amsterdam. (Published by: BMJ Publishing Group Ltd, 1995-08-19)
    • The G8 and access to medicines: no more broken promises.

      Moran, M; Ford, N; Médecins Sans Frontières, EC1N 8QX, London, UK. (Elsevier, 2003-05-10)
    • Generic medicines are not substandard medicines.

      Ford, N; 't Hoen, E (Elsevier, 2002-04-13)
    • A Global Biomedical R&D Fund and Mechanism for Innovations of Public Health Importance

      Balasegaram, Manica; Bréchot, Christian; Farrar, Jeremy; Heymann, David; Ganguly, Nirmal; Khor, Martin; Lévy, Yves; Matsoso, Precious; Minghui, Ren; Pécoul, Bernard; et al. (Public Library of Science, 2015-05-11)
      Bernard Pécoul and colleagues call for the establishment of a global biomedical R&D fund as a key priority of the G7 summit in June 2015.
    • Global Framework on Essential Health R&D.

      Chirac, P; Torreele, E; Médecins Sans Frontières, 75544 Paris cedex 11, France. pierchir@club-internet.fr (Elsevier, 2006-05-13)
    • Global Health Education in Germany: An Analysis of Current Capacity, Needs and Barriers

      Kaffes, I; Moser, F; Pham, M; Oetjen, A; Fehling, M (BioMed Central, 2016-11-25)
      In times of increasing global challenges to health, it is crucial to create a workforce capable of tackling these complex issues. Even though a lack of GHE in Germany is perceived by multiple stakeholders, no systematic analysis of the current landscape exists. The aim of this study is to provide an analysis of the global health education (GHE) capacity in Germany as well as to identify gaps, barriers and future strategies.
    • The Global Health Fund: moral imperative or industry subsidy?

      Ford, N; 't Hoen, E; Médecins Sans Frontières, 124-132 Clerkenwell Road, EC1R 5DJ, London, UK. (11520549, 2001-08-18)
    • Global health training and postgraduate medical education in Australia: the case for greater integration

      Mitchell, Rob D; Jamieson, Jennifer C; Parker, Jake; Hersch, Fred B; Wainer, Zoe; Moodie, A Rob; Emergency Department, Townsville Hospital, Townsville, QLD, Australia. mitchell.rob@me.com (Australian Medical Association, 2013-04-01)
      Global health (GH) training is well established overseas (particularly in North America) and reflects an increasing focus on social accountability in medical education. Despite significant interest among trainees, GH is poorly integrated with specialty training programs in Australia. While there are numerous benefits from international rotations in resource-poor settings, there are also risks to the host community, trainee and training provider. Safe and effective placements rely on firm ethical foundations as well as strong and durable partnerships between Australian and overseas health services, educational institutions and GH agencies. More formal systems of GH training in Australia have the potential to produce fellows with the skills and knowledge necessary to engage in regional health challenges in a global context.
    • Global plagues and the Global Fund: Challenges in the fight against HIV, TB and malaria.

      Tan, D; Upshur, R; Ford, N; Department of Medicine, University of Toronto, University Health Network, Toronto General Hospital Site, R, Fraser Elliott Building 3-Suite 805, 190 Elizabeth St, Toronto, Ontario, M5G 2C4, Canada. darrell.tan@utoronto.ca (BMC, 2003-04-01)
      BACKGROUND: Although a grossly disproportionate burden of disease from HIV/AIDS, TB and malaria remains in the Global South, these infectious diseases have finally risen to the top of the international agenda in recent years. Ideal strategies for combating these diseases must balance the advantages and disadvantages of 'vertical' disease control programs and 'horizontal' capacity-building approaches. DISCUSSION: The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) represents an important step forward in the struggle against these pathogens. While its goals are laudable, significant barriers persist. Most significant is the pitiful lack of funds committed by world governments, particularly those of the very G8 countries whose discussions gave rise to the Fund. A drastic scaling up of resources is the first clear requirement for the GFATM to live up to the international community's lofty intentions. A directly related issue is that of maintaining a strong commitment to the treatment of the three diseases along with traditional prevention approaches, with the ensuing debates over providing affordable access to medications in the face of the pharmaceutical industry's vigorous protection of patent rights. SUMMARY: At this early point in the Fund's history, it remains to be seen how these issues will be resolved at the programming level. Nevertheless, it is clear that significant structural changes are required in such domains as global spending priorities, debt relief, trade policy, and corporate responsibility. HIV/AIDS, tuberculosis and malaria are global problems borne of gross socioeconomic inequality, and their solutions require correspondingly geopolitical solutions.
    • Health development versus medical relief: the illusion versus the irrelevance of sustainability.

      Ooms, G; Belgian section of Médecins Sans Frontières. ooms@brussels.msf.org (Public Library of Science, 2006-08)
    • Health in the service of state-building in fragile and conflict affected contexts: an additional challenge in the medical-humanitarian environment

      Philips, Mit; Derderian, Katharine (BioMed Central (Springer Science), 2015-03-29)
      Global health policy and development aid trends also affect humanitarian health work. Reconstruction, rehabilitation and development initiatives start increasingly earlier after crisis, unleashing tensions between development and humanitarian paradigms. Recently, development aid shows specific interest in contexts affected by conflict and fragility, with increasing expectations for health interventions to demonstrate transformative potential, including towards more resilient health systems as a contribution to state-building agendas.
    • Health leadership in sub-Saharan Africa.

      Harries, Anthony D; Schouten, Erik J; Ben-Smith, Anne; Zachariah, Rony; Phiri, Sam; Sangala, Wesley O O; Jahn, Andreas; Old Inn Cottage, Vears Lane, Colden Common, Winchester SO21 1TQ, UK adharries@theunion.org. (2009-10)
    • Historic Opportunity for WHO to Re-Assert Leadership.

      Gillies, R; von Schoen-Angerer, T; 't Hoen, E; Médecins Sans Frontières, Geneva, Switzerland. (Published by: Elsevier, 2006-10-21)
    • Hope for Haiti?

      Veeken, H; Médecins Sans Frontières, Amsterdam, Netherlands. (Published by: BMJ Publishing Group Ltd, 1993-07-31)
      Haiti, one of the world's five poorest nations, gets international attention because of the number of refugees who leave by boat in search of a better future. The 80,000 inhabitants of Ile de la Gonave are neglected, even in Haiti--there is no government medical post, and facilities in the health posts run by missions are minimal. Typhoid and cholera epidemics threaten the island. Médecins Sans Frontières plans to send staff and supplies and train local health workers.
    • How health systems in sub-Saharan Africa can benefit from tuberculosis and other infectious disease programmes.

      Harries, A D; Jensen, P M; Zachariah, R; Rusen, I D; Enarson, D A; International Union Against Tuberculosis and Lung Disease, Paris, France. adharries@theunion.org (2009-10)
      Weak and dysfunctional health systems in low-income countries, particularly in sub-Saharan Africa, are recognised as major obstacles to attaining the health-related Millennium Development Goals by 2015. Some progress is being made towards achieving the targets of Millennium Development Goal 6 for tuberculosis (TB), HIV/AIDS and malaria, with the achievements largely resulting from clearly defined strategies and intervention delivery systems combined with large amounts of external funding. This article is divided into four main sections. The first highlights the crucial elements that are needed in low-income countries in sub-Saharan Africa to deliver good quality health care through general health systems. The second discusses the main characteristics of infectious disease and TB control programmes. The third illustrates how TB control and other infectious disease programmes can help to strengthen these components, particularly in human resources; infrastructure; procurement and distribution; monitoring, evaluation and supervision; leadership and stewardship. The fourth and final section looks at progress made to date at the international level in terms of policy and guidelines, with some specific suggestions about this might be moved forward at the national level. For TB and other infectious disease programmes to drive broad improvements in health care systems and patient care, the lessons that have been learnt must be consciously applied to the broader health system, and sufficient financial input and the engagement of all players are essential.