• 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.
    • How patent law reform can improve affordability and accessibility of medicines in South Africa: Four medicine case studies

      Tomlinson, C; Waterhouse, C; Hu, YQ; Meyer, S; Moyo, H (Publisher Health & Medical Publishing Group, 2019-05-31)
      South Africa (SA) is in the process of amending its patent laws. Since its 2011 inception, Fix the Patent Laws, a coalition of 40 patient groups, has advocated for reform of SA’s patent laws to improve affordability of medicines in the country. Building on two draft policies (2013, 2017) and a consultative framework (2016) for reform of SA’s patent laws, Cabinet approved phase 1 of the Intellectual Property Policy of the Republic of South Africa on 23 May 2018. Fix the Patent Laws welcomed the policy, but highlighted concerns regarding the absence of important technical details, as well as the urgent need for government to develop bills, regulations and guidelines to provide technical detail and to codify and implement patent law reform in the country. In this article, we explore how reforms proposed in SA’s new intellectual property policy could improve access to medicine through four medicine case studies.
    • Humanitarian Action and Military Intervention: Temptations and Possibilities.

      Weissman, F; Médecins Sans Frontières France, 8 Rue Saint Sabin, Paris 75011, France. Fabrice.weissman@paris.msf.org (Published by Wiley-Blackwell, 2004-06)
      Although the war in Liberia in July 2003 claimed hundreds of lives, the international community was reluctant to intervene. In this article, the author debates the question: does international military intervention equal protection of populations? The role of humanitarian organisations in military intervention is considered. Aid organisations cannot call for deployment of a protection force without renouncing their autonomy or appealing to references outside their own practices. Such organisations provide victims with vital assistance and contribute to ensuring that their fate becomes a stake in political debate by exposing the violence that engulfs them, without substituting their own voices for those of the victims. The political content of humanitarian action is also outlined and military intervention in the context of genocide is discussed. The author concludes that the latter is one of the rare situations in which humanitarian actors can consider calling for an armed intervention without renouncing their own logic.
    • In Resource-Limited Settings Good Early Outcomes Can be Achieved in Children Using Adult Fixed-Dose Combination Antiretroviral Therapy.

      O'Brien, D; Sauvageot, D; Zachariah, R; Humblet, P; AIDS Working Group, Medecins Sans Frontieres, Plantage Middenlaan 14, 1001 EA Amsterdam, The Netherlands. daniel.obrien@amsterdam.msf.org (2006-10-03)
      OBJECTIVES: To (a) determine early treatment outcomes and (b) assess safety in children treated with adult fixed-dose combination (FDC) antiretroviral tablets. SETTING: Sixteen Medecins Sans Frontieres (MSF) HIV programs in eight countries in resource-limited settings (RLS). METHODS: Analysis of routine program data gathered June 2001 to March 2005. RESULTS: A total of 1184 children [median age, 7 years; inter-quartile range (IQR), 4.6-9.3] were treated with antiretroviral therapy (ART) of whom 616(52%) were male. At ART initiation, Centres for Disease Control stages N, A, B and C were 9, 14, 38 and 39%, respectively. Children were followed up for a median period of 6 months (IQR, 2-12 months). At 12 months the median CD4 percentage gain in children aged 18-59 months was 15% (IQR, 6-18%), and the percentage with CD4 gain < 15% was reduced from 85% at baseline to 11%. In those aged 60-156 months, median CD4 cell count gain was 275 cells/microl (IQR, 84-518 cells/microl), and the percentage with CD4 < 200 cells/mul reduced from 51% at baseline to 11%. Treatment outcomes included; 1012 (85%) alive and on ART, 36 (3%) deaths, 15 (1%) stopped ART, 89 (8%) lost to follow-up, and 31 (3%) with unknown outcomes. Overall probability of survival at 12 months was 0.87 (0.84-0.89). Side effects caused a change to alternative antiretroviral drugs in 26 (2%) but no deaths. CONCLUSIONS: Very satisfactory early outcomes can be achieved in children in RLS using generic adult FDC antiretroviral tablets. These findings strongly favour their use as an "interim solution" for scaling-up ART in children; however, more appropriate pediatric antiretroviral drugs remain urgently needed.
    • In search of the 'new informal legitimacy' of Médecins Sans Frontières

      Calain, Philippe; Unité de Recherche sur les Enjeux et Pratiques Humanitaires (UREPH), Médecins Sans Frontières-Switzerland (Oxford University Press, 2011-12-30)
      For medical humanitarian organizations, making their sources of legitimacy explicit is a useful exercise, in response to: misperceptions, concerns over the 'humanitarian space', controversies about specific humanitarian actions, challenges about resources allocation and moral suffering among humanitarian workers. This is also a difficult exercise, where normative criteria such as international law or humanitarian principles are often misrepresented as primary sources of legitimacy. This essay first argues for a morally principled definition of humanitarian medicine, based on the selfless intention of individual humanitarian actors. Taking Médecins Sans Frontières (MSF) as a case in point, a common source of moral legitimacy for medical humanitarian organizations is their cosmopolitan appeal to distributive justice and collective responsibility. More informally, their legitimacy is grounded in the rightfulness of specific actions and choices. This implies a constant commitment to publicity and accountability. Legitimacy is also generated by tangible support from the public to individual organizations, by commitments to professional integrity, and by academic alliances to support evidence-based practice and operational research.
    • The 'Indirect Costs' of Underfunding Foreign Partners in Global Health Research: A Case Study

      Crane, J; Andia B; Fouad, T; Boum, Y; R Bangsberg, D (Taylor & Francis, 2017-09-16)
      This study of a global health research partnership assesses how U.S. fiscal administrative policies impact capacity building at foreign partner institutions. We conducted a case study of a research collaboration between Mbarara University of Science and Technology (MUST) in Mbarara, Uganda, and originally the University of California San Francisco (UCSF), but now Massachusetts General Hospital (MGH). Our case study is based on three of the authors' experiences directing and working with this partnership from its inception in 2003 through 2015. The collaboration established an independent Ugandan non-profit to act as a local fiscal agent and grants administrator and to assure compliance with the Ugandan labour and tax law. This structure, combined with low indirect cost reimbursements from U.S. federal grants, failed to strengthen institutional capacity at MUST. In response to problems with this model, the collaboration established a contracts and grants office at MUST. This office has built administrative capacity at MUST but has also generated new risks and expenses for MGH. We argue that U.S. fiscal administrative practices may drain rather than build capacity at African universities by underfunding the administrative costs of global health research, circumventing host country institutions, and externalising legal and financial risks associated with international work.
    • An integrated approach of community health worker support for HIV/AIDS and TB care in Mozambique.

      Simon, S; Chu, K; Frieden, M; Candrinho, B; Ford, N; Schneider, H; Biot, M (2009-07-17)
      ABSTRACT: BACKGROUND: The need to scale up treatment for HIV/AIDS has led to a revival in community health workers to help alleviate the health human resource crisis in sub-Saharan Africa. Community health workers have been employed in Mozambique since the 1970s, performing disparate and fragmented activities, with mixed results. METHODS: A participant-observer description of the evolution of community health worker support to the health services in Angonia district, Mozambique. RESULTS: An integrated community health team approach, established jointly by the Ministry of Health and Medecins Sans Frontieres in 2007, has improved accountability, relevance, and geographical access for basic health services. CONCLUSIONS: The community health team has several advantages over 'disease-specific' community health worker approaches in terms of accountability, acceptability, and expanded access to care.
    • International health links manual

      Zachariah, Rony (Elsevier Ltd, 2010-03-01)
    • International nurse migration and HIV/AIDS.

      Lynch, S; Lethola, P; Ford, N (American Medical Association, 2008-09-03)
    • Interventions to Control Virus Transmission During an Outbreak of Ebola Hemorrhagic Fever: Experience from Kikwit, Democratic Republic of the Congo, 1995.

      Kerstiëns, B; Matthys, F; Médecins sans Frontières, Brussels, Belgium. bkerstie@jhsph.edu (Published by Infectious Diseases Society of America, 1999-02)
      On 6 May 1995, the Médecins sans Frontières (MSF) coordinator in Kinshasa, Democratic Republic of the Congo (DRC), received a request for assistance for what was believed to be a concurrent outbreak of bacillary dysentery and viral hemorrhagic fever (suspected Ebola hemorrhagic fever [EHF]) in the town of Kikwit, DRC. On 11 May, the MSF intervention team assessed Kikwit General Hospital. This initial assessment revealed a nonfunctional isolation ward for suspected EHF cases; a lack of water and electricity; no waste disposal system; and no protective gear for medical staff. The priorities set by MSF were to establish a functional isolation ward to deal with EHF and to distribute protective supplies to individuals who were involved with patient care. Before the intervention, 67 health workers contracted EHF; after the initiation of control measures, just 3 cases were reported among health staff and none among Red Cross volunteers involved in body burial.
    • Introductory note: The access to Essential Medicines Campaign.

      Kindermans, J M; Matthys, F; MSF International, 37 Rue de la Tourelle, 1040 Brussels, Belgium. (Wiley-Blackwell, 2001-11)
      To ensure access to essential medicines for disadvantaged populations there are at least three conditions to be met: drugs prices must be affordable for poor countries; research and development of drugs for tropical diseases must take place; and there is a need for health exceptions to trade agreements.