The Health Systems Funding Platform : is this where we thought we were going?

Background: In March 2009, the Task Force for Innovative International Financing for Health Systems recommended "a health systems funding platform for the Global Fund, GAVI Alliance, the World Bank and others to coordinate, mobilize, streamline and channel the flow of existing and new international resources to support national health strategies." Momentum to establish the Health Systems Funding Platform was swift, with the World Bank convening a Technical Workshop on Health Systems Strengthening (HSS), and serial meetings organized to progress the agenda. Despite its potential significance, there has been little comment in peer-reviewed literature, though some disquiet in the international development community around the scope of the Platform and the capacity of the partners, which appears disproportionate to the available information. Methods: This case study uses documentary analysis, participant observation and 24 in-depth interviews to examine the processes of development and key issues raised by the Platform. Results: The findings show a fluid and volatile process, with debate over whether ongoing engagement in HSS by Global Fund and GAVI represents a dilution of organizational focus, risking ongoing support, or a paradigm shift that facilitates the achievement of targeted objectives, builds systems capacity, and will attract additional resources. Uncertainty in the development of the Platform reflects the flexibility of the recently formed global health initiatives, and the instability of donor commitments, particularly in the current financial climate. But implicit in the conflict is tension between key global stakeholders over defining and ownership of the health systems agenda. Conclusions: The tensions appear to have been resolved through a focus on national planning, applying International Health Partnership principles, though the global financial crisis and key personnel changes may yet alter outcomes. Despite its dynamic evolution, the Platform may offer an incremental path towards increasing integration around health systems, that has not been previously possible

The rise of companies from emerging markets in global health governance: opportunities and challenges

The article analyses the involvement of pharmaceutical companies from emerging markets in global health governance. It finds that they play a central role as low-cost suppliers of medicines and vaccines and, increasingly, new technologies. In so doing, pharmaceutical companies from emerging markets have facilitated the implementation of a key goal of global health policy: widening access to pharmaceutical treatment and prevention. Yet, looking closer at the political economy underlying their involvement, the article exposes a tension between this policy goal and the political economy of pharmaceutical development and production. By declaring access to pharmaceuticals a goal of global health policy, governments and global health partnerships have made themselves dependent on pharmaceutical companies to supply them. Moreover, to provide pharmaceutical treatment and prevention at the global level, they depend on companies to supply medicines and vaccines at extremely low prices. Yet, the development and production of pharmaceuticals is organized around commercial incentives that are at odds with the prices required. The increasing involvement of low-cost suppliers from emerging markets mitigates this tension in the short run. In the long run, this tension endangers the sustainability of global access policies and may even undermine some of the successes already achieved

An Iterative Cyclic Algorithm for Designing Vaccine Distribution Networks in Low and Middle-Income Countries

The World Health Organization's Expanded Programme on Immunization (WHO-EPI) was developed to ensure that all children have access to common childhood vaccinations. Unfortunately, because of inefficient distribution networks and cost constraints, millions of children in many low and middle-income countries still go without being vaccinated. In this paper, we formulate a mathematical programming model for the design of a typical WHO-EPI network with the goal of minimizing costs while providing the opportunity for universal coverage. Since it is only possible to solve small versions of the model optimally, we describe an iterative heuristic that cycles between solving restrictions of the original problem and show that it can find very good solutions in reasonable time for larger problems that are not directly solvable.Comment: International Joint Conference on Industrial Engineering and Operations Management- ABEPRO-ADINGOR-IISE-AIM-ASEM (IJCIEOM 2019). Novi Sad, Serbia, July 15-17t

Spotlight on islands.On the origin and diversification of an ancient lineage of the Italian wall lizard Podarcis siculus in the western Pontine Islands

Groups of proximate continental islands may conceal more tangled phylogeographic patterns than oceanic archipelagos as a consequence of repeated sea level changes, which allow populations to experience gene flow during periods of low sea level stands and isolation by vicariant mechanisms during periods of high sea level stands. Here, we describe for the first time an ancient and diverging lineage of the Italian wall lizard Podarcis siculus from the western Pontine Islands. We used nuclear and mitochondrial DNA sequences of 156 individuals with the aim of unraveling their phylogenetic position, while microsatellite loci were used to test several a priori insular biogeographic models of migration with empirical data. Our results suggest that the western Pontine populations colonized the islands early during their Pliocene volcanic formation, while populations from the eastern Pontine Islands seem to have been introduced recently. The inter-island genetic makeup indicates an important role of historical migration, probably due to glacial land bridges connecting islands followed by a recent vicariant mechanism of isolation. Moreover, the most supported migration model predicted higher gene flow among islands which are geographically arranged in parallel. Considering the threatened status of small insular endemic populations, we suggest this new evolutionarily independent unit be given priority in conservation efforts

Multiactor Global Funds: New Tools to Address Urgent Global Problems

international organizations, private sector, funding, governance

Podarcis siculus latastei (Bedriaga, 1879) of the western pontine islands (italy) raised to the species rank, and a brief taxonomic overview of podarcis lizards

In recent years, great attention has been paid to many Podarcis species for which the observed intra-specific variability often revealed species complexes still characterized by an unresolved relationship. When compared to other species, P. siculus underwent fewer revisions and the number of species hidden within this taxon may have been, therefore, underestimated. However, recent studies based on genetic and morphological data highlighted a marked differentiation of the populations inhabiting the Western Pontine Archipelago. In the present work we used published genetic data (three mitochondrial and three nuclear gene fragments) from 25 Podarcis species to provide a multilocus phylogeny of the genus in order to understand the degree of differentiation of the Western Pontine populations. In addition, we analyzed new morphometric traits (scale counts) of 151 specimens from the main islands of the Pontine Archipelago. The phylogenetic analysis revealed five principal Podarcis groups with biogeographic consistency. The genetic distinctiveness of the Podarcis populations of the Western Pontine Islands is similar or even more ancient than those observed in numerous other pairs of Podarcis sister species. In the light of these evidences we raise the Western Pontine lizards to specific rank; thus they should be referred to as Podarcis latastei

Boosting the Immunization Workforce: Lessons from the Merck Vaccine Network - Africa

This report shares lessons learned from The Merck Company Foundation's decade of experience building immunization capacity in Africa. The Merck Vaccine Network -- Africa, a philanthropic initiative to train immunization managers in Kenya, Mali, Uganda, and Zambia, suggests seven key lessons that can help other funders, governments, and NGOs designing or implementing similar vaccine delivery training programs improve the effectiveness and sustainability of their work.Merck's experience designing and supporting the initiative can offer valuable lessons for other actors in the immunization and broader global health fields who are engaged in or planning similar work. Specifically, we identify seven forward-looking lessons that can increase the effectiveness and sustainability of programs to build the capacity of the vaccine workforce in developing countries:Conduct a rigorous needs assessment to anchor efforts in local needs and priorities;Perform ongoing monitoring and evaluation (M&E) to enable programs to adapt, improve, and generate evidence of impact to attract new partners and funding;Create a sustainability plan at the outset to ensure that program impact is maintained beyond the conclusion of initial funding;Embed programs into local health systems to ensure that investments leverage existing infrastructure, relationships, and resources, and that impact can be sustained beyond the life of the program;Employ locally-adapted curricula and appropriate teaching techniques to maximize transfer and retention of relevant knowledge;Incorporate supportive supervision into programs to ensure that transferred knowledge is maintained and acted upon;Facilitate and support regular convening and communication, enabling continuous learning for improvement.In addition to describing the approach taken by MVN-A and the results achieved in the four focus countries, this paper provides additional detail on each lesson, supported by case studies from the MVNA experience

Impact of Switch Options on the Economics of Pneumococcal Conjugate Vaccine (PCV) Introduction in Indonesia

As one of Gavi, the Vaccine Alliance (previously the Global Alliance for Vaccines and Immunization), graduating countries, Indonesia is still eligible to access Gavi price for PCV13, PCV10 A and B. This study aims to estimate the economic impact of switch from the existing product/presentation of PCV (single-dose of PCV13) to the new product/presentation of PCV (multi-dose of PCV13, PCV10 A and B) since PCV is one of the most expensive vaccines in the Expanded Program on Immunization (EPI) schedule. Assuming that Gavi-Advance Market Commitment (AMC) price for all PCVs can be accessed in 2021, the use of multi-dose PCV13, PCV10 A and PCV10 B with Gavi-AMC price in 2021-2024 were considered as respective scenarios. The result showed that the scenario assuming the use of single-dose of PCV13 with contract price in 2019-2020 that would be switched into multi-dose of PCV10 B with Gavi-AMC price in 2021-2024 resulted in the highest potential saving, compared with other scenarios. Our analysis suggests an economic advantage to switch from single-dose into a multi-dose presentation. Vaccination coverage, vaccine price, vaccine wastage and additional Gavi-AMC vaccine costs were considered to be the most influential parameter affecting the savings in all scenarios. Applying the effectiveness of PCV13 and PCV10 A on reducing the risk for invasive pneumococcal disease (IPD), potential averted incidence of IPD in children under one year of age during 2019-2024 would be 246,164 and 105,587 in both scenarios. Despite the result confirmed that PCV13 may provide an additional benefit, a more comprehensive economic evaluation study is required to investigate further the comparison of cost-effectiveness values among all PCVs in Indonesia