Category Archive for 'strengthening health systems'

A widow and her children in Afghanistan.

The federal budget battle is not yet over, and global health funding is in jeopardy.

In previous posts on January 28 and February 15, I urged you to make your Senators aware that global health funding is a priority to you. Budget cuts for critical health programs – even short term – will have disastrous long term consequences. Cutting too deeply would hamper our ability to prevent or cure illness and to support the health and wellbeing of the millions who depend on sustained funding. Thanks in part to the advocacy of people like you, the cuts to international development for the rest of this fiscal year were less drastic than many feared.

The fight is not over, and the discussion over the past months demonstrates that many politicians consider global health programs to be expendable. Although global health funding may not be drastically reduced in the short term, these essential programs are under serious threat in the coming year (FY2012).

For this year’s annual Global Health Week of Action (May 1-7, 2011), let’s make sure that DC knows that health professionals see that global health funding is critical – to protect the right to health, to advance international development and security, and to avoid needless suffering and death.

Next week, I’ll share the materials for the Global Health Week of Action. I’ll also launch an exciting new resource so that you can plan your own educational or advocacy inititative.

US leadership is crucial to improving health

For over 100 years, America has been a leader in the efforts  to improve global health. The US supports the Millennium Development Goals, which means reducing deaths in children less than five years of age by two-thirds, lowering the maternal mortality rate by 7%, and halting the HIV/AIDS, tuberculosis and malaria epidemics. This has been a nonpartisan issue for years. Under both Republican and Democratic administrations, the U.S. government has joined other nations to innovate, lead, and fund health programs worldwide.

There is much to be proud of. As a result of U.S. leadership on global health, the world’s most vulnerable communities are reaping extraordinary health dividends. With America at the forefront of the global AIDS response, the number of AIDS deaths has declined by almost a quarter over the last decade, while the number of new HIV infections has fallen by a comparable amount. In part due to America’s considerable investments in malaria control, global production of insecticide-treated bed nets has risen five-fold since 2004, and the number of households regularly using bed nets for malaria prevention has increased more than 40-fold in some African countries. U.S. support has also proved vital to achieving recent improvements in TB case detection and treatment rates and reductions in overall global TB burden, accomplishments that have effectively halted what was only recently an out-of-control growth in new TB cases.

U.S. leadership has been especially critical in promoting the health and wellbeing of women and children. Since 1990, the childhood mortality rate has fallen by nearly 30%. Due in part to U.S. support for health systems strengthening in low-income countries, the number of maternal deaths decreased by 34 percent from 1990 to 2008, even as the population of reproductive-aged women increased.

Don’t jeopardize fragile gains: maintain or expand global health funding

In short, the world is within reach of achieving one of the most important of all global goals—sharply reducing health inequities. Yet recent gains are exceedingly fragile, and the drastic cuts in global health funding that have been proposed place the advances of the last two decades in grave peril.

As Michael Gerson, a former advisor to President George Bush  in the creation of the President’s Malaria Initiative, says in a recent Washington Post article,

Global health programs are not analogous to many other categories of federal spending, such as job training programs or support for public television. A child either receives malaria treatment or does not. The resulting risk of death is quantifiable. The outcome of returning to 2008 spending levels, as Republicans propose, is predictable. Fiscal conservatives tend to justify these reductions as shared sacrifice. But not all sacrifices are shared equally. Some get a pay freeze. Some get a benefit adjustment. Others get a fever and a small coffin. This is not fiscal prudence. It is the prioritization of the most problematic spending cuts — a disproportionate emphasis on the least justifiable reductions. One can be a budget cutter and still take exception to cuts at the expense of the most vulnerable people on earth. In Britain, Prime Minister David Cameron is pursuing even greater austerity while increasing funding for development.

Although the need for fiscal restraint has placed policymakers in a difficult position, proposed cuts in global health programs would contribute very little to deficit reduction.

International affairs constitutes only about 1% of the federal budget, with health assistance representing only a fraction of the larger account for foreign assistance. These eminently affordable investments are humanitarian, diplomatic, and economically sound, as they enable people to continue working and reduce the likelihood of disease transmission, thereby averting substantial future health care costs.

Join PHR in May for the Global Health Week of Action. Ensure that the lives of the most vulnerable are not placed in even greater jeopardy.

Every summer, I promise myself that I’ll make the time to time to read the books that I’ve been meaning to get to all year. Whether I’m parked in front of the air conditioning or in the last light of dusk on the porch, there’s just something great about reading that’s not assigned. Summer is my chance to choose what I want to read: something fun, something that will deepen my understanding of the world, or something that will inspire me to return to work with renewed commitment, awareness, and energy. I want to read something that is indulgent, informative, and inspirational.

The PHR National Student Program is busy this summer, expanding and improving the resources available to Chapters. Among other things, we’re creating lists to help you discover new resources and opportunities. In honor of summer reading lists, I wanted to give you a glimpse of our new Recommended Reading list.

Here’s a list of some excellent books, articles, and blog posts that will appear on the Recommended Reading list. Most were suggested by PHR staff and interns. Although Laurie Garrett’s 800-page Betrayal of Trust: The Collapse of Global Public Health might not be everyone’s idea of an ideal beach read, it might be just what you’ve been looking for.

Have a favorite that you didn’t see here? Maybe something that inspired your interest in health or human rights, or offered a new perspective on a topic near and dear to your heart? Post it in the Comments section below, and we might include it in the final version of the Recommended Reading list.


Health and Human Rights: A Reader, Jonathan Mann, Michael A. Grodin, Sofia Gruskin, and George J. Annas.  (1999)

Perspectives on Health and Human Rights, Sofia Gruskin, Michael A. Grodin, George J. Annas, and Stephen P. Marks.  (2005)

These texts are often used in health and human rights courses.  Both are comprehensive anthologies of foundational essays on health and human rights, and examine issues from ethnic cleansing to women’s reproductive rights.

The Oath: A Surgeon Under Fire, Khassan Baiev and Ruth Daniloff. Dr. Baiev was caught in the the struggle between Chechnya and Russia. Regardless of their nationality or whether civilian or military, he treated everybody under extraordinarily difficult circumstances.  Considered a traitor to both sides, he was called a “bandit-doctor” (for treating Chechens) and a “pig-doctor” (for treating Russians). For years, PHR has worked to protect Colleagues at Risk – clinicians who are targeted for adhering to their Hippocratic Oath, despite the political situation.

The Spirit Catches You and You Fall Down, Anne Fadiman. Described by various PHR staff as “fantastic,” “riveting,” and “devastating and totally addictive,” this describes the clash of two cultures over a child’s health. Anne Fadiman writes with the insight of an anthropologist and the compassion of a friend. I worked with refugees for years, and I also saw heartbreaking conflict between people who each had a patient’s best interests at heart, but had very different beliefs about illness and health.

Betrayal of Trust: The Collapse of Global Public Health, Laurie Garrett.  As in another of Garrett’s massive tomes, The Coming Plague, Garrett uses investigative reporting to analyze public health preparedness.

The Bone Woman: A Forensic Anthropologist’s Search for Truth in the Mass Graves of Rwanda, Bosnia, Croatia, and Kosovo, Clea Koff. Koff takes the reader inside her life as a forensic anthropologist to see what it’s like to excavate mass graves and build evidence of human rights violations. PHR’s International Forensic Program relies on these skills in Afghanistan, Central America, and elsewhere.

The Dark Side: The Inside Story of How The War on Terror Turned into a War on American Ideals, Jane Mayer. This dramatic narrative reveals the decisions behind the controversial excesses of the war on terror and considers the impact of these choices. For more background and an update, visit PHR’s reports on torture of US detainees.

PHR Reports

From Persecution to Prison: The Health Consequences of Detention for Asylum Seekers. Asylum seekers who come to the U.S. to escape torture, persecution, violence or abuse are often locked up in inhuman conditions. PHR conducted the first systematic and comprehensive study about the impact of detention on asylum seekers’ mental health.

Achieving the MDGs by Investing in Human Resources for Health and The Right to Health and Health Workforce Planning. Access to healthcare depends in large part on the ability and distribution of a country’s health workforce. Investments that sidestep the training, payment and supervision of healthcare workers do not build the overall health system.

Stateless and Starving: Persecuted Rohingya Flee Burma and Starve in Bangladesh. In recent months Bangladeshi authorities have waged an unprecedented campaign of arbitrary arrest, illegal expulsion and forced internment against Burmese refugees. In this emergency report, PHR presents new data and documents dire conditions for these persecuted Rohingya refugees in Bangladesh. PHR’s medical investigators warn that critical levels of acute malnutrition and a surging camp population without access to food aid will cause more deaths from starvation and disease if the humanitarian crisis is not addressed.


Health and Human Rights is published by the FXB Center for Health and Human Rights at Harvard University. The original editor-in-chief was Jonathan Mann, succeed by Sofia Gruskin and then Paul Farmer, all pioneers in the field. By posing the question, “What is a rights-based approach to health and why should we care?” this issue began a series that dealt with fundamental concepts regarding health as a human right.  Subsequent issues tackle accountability (10:2), participation (11:1), and non-discrimination and equality (11:2). The series concludes with the most recent issue on international assistance and cooperation, edited by Jennifer Leaning, the new FXB director and a former PHR Board member. All material is freely available online.

Health and Human Rights Education in U.S. Schools of Medicine and Public Health: Current Status and Future Challenges, L. Emily Cotter et al.  PHR’s Senior Medical Advisor Vince Iacopino and the other authors evaluated obstacles to health and human rights education at schools of medicine and public health across the country.

Health and Human Rights, Jonathan Mann et al. A close look at the complementary ways that health and human rights define and advance human well-being:

  • The Impact of Health Policies, Programs and Practices on Human Rights
  • Health Impacts Resulting from Violations of Human Rights
  • The Inextricable Linkage Between Health and Human Rights

The Challenge of Global Health, Laurie Garrett. Garrett’s critique of misdirected investment in global health got a strong reaction from the media and the global health establishment. Don’t miss the exchange between Paul Farmer and Laurie Garrett. Although the funding and policy environment has evolved since this was published, it’s a glimpse of a critical moment in global health.

Blog posts

The Right to Health: A Conversation with Helen Potts, PhD on the Physicians for Human Rights site. An informative and comprehensive look at the history and meaning of the right to health.

Refugees in America: Faces and Stories Behind the Refugee Protection Act. This post by Erin Hustings, PHR’s Asylum Advocacy Associate, on the PHR blog Health Rights Advocate, offers a personalized look at the refugees who are denied asylum in the United States because of unnecessary obstacles and technicalities.


It’s official: the Global Health Week of Action is here!  The GHWA is a chance to move from education to advocacy on your campus.

The Chapters we’ve talked to so far are doing a range of activities – from direct advocacy with their Representatives, to speaker’s panels, a health fair, fundraisers, film screenings, and a blood drive! World Health Day is April 7, so April 4-10 is the official week of action – but your school might choose a different week in April to accommodate your campus calendars.

This year we’re encouraging chapters to focus their GHWA on the global health workforce crisis and the 2010 Global HEALTH Act (HR 4933).  Rep. Barbara Lee (D-CA) has introduced the bill in the House!  For the Global HEALTH Act to be successful, the more co-sponsors, the better.

How can you tell your Representatives that you want them to co-sponsor?

These letters, petitions, phone calls and district meetings send a clear message to your Representative: We want you to support the Global HEALTH Act. You can also forward some friends the link to the petition, post it on FB, and tweet it!

PHR has put together a GHWA Toolkit that includes an Issue and Action Guide, ideas for great events, suggestions on how to fundraise and publicize, and resources to share with your community. If you’d like to brainstorm together or discuss what resources PHR has for you, just email or call me! This GHWA is a chance to energize your Chapter, build interest in health and human rights education (HHRE) – and make a real difference at the same time.





The Global Health Act (House Resolution 4933) has been introduced in Congress by Representative Barbara Lee (D-CA). Now is the best time to garner support from our Representatives. Why not start by scheduling an in-district meeting for your Global Health Week of Action?

Meeting with government officials is easier than you think!

Contacting government officials lets you take an active role in influencing public policy. Meetings with constituents give policymakers the opportunity to learn about issues and make informed policy decisions. As a health professional student, you have a powerful voice to promote and protect human rights.

Things to Consider When Scheduling a Meeting

  • Timing: Start calling the office a few weeks ahead of time, because it may take several calls or faxes to schedule an appointment. Ask for the scheduler’s name and the name of the appropriate aide. Find the contact information for your Representatives, then fax or email the meeting request. You can use our sample Meeting Request letter (.doc) as a starting point. It’s likely that you’ll meet with an aide, rather than the congressperson; your meeting will still have an impact on the policymaker.
  • Participation: Two to four people is ideal. Include people who are from the legislator’s district or state who have some level of expertise on the issue, and people who are articulate, respectful, and confident.
  • Preparation: Know your facts. Read the bill before you meet with your representative! Be able to explain, succinctly, why this issue is important to you. Practice and know who will say what. If you don’t know the answer to a question that arises, don’t worry: tell the staffer you will get back to then—a great way to ensure follow up and continued conversation after the meeting. Use the Global HEALTH Act fact sheet (pdf) to develop your talking points. Know as much as possible about the member’s background in general (especially which committees she or he sits on) and on your issue.

Tips for the Meeting – Remember the 4 Cs!

  • Connection: Recognize past support of this issue or others. Chat about personal connections or relevant news. Be polite, respectful, and formal when addressing the member of Congress.
  • Context: Give background info on the issue, why it’s so important, your connection to it (perhaps most important), and the Representative’s connection to it.
  • Commitment: Do not be afraid to ask for what you want: “Can we count on your support for the 2010 Global Health Act?” If you don’t ask, you don’t know for sure their position.
  • Catapult: End on a friendly note. Thank the member or aide. Get the card of the appropriate aide. Discuss the next steps for follow-up.

After you have met with your congressperson please complete the Meeting Report form (.doc) so PHR can follow up and leverage your work. These meetings can make a big difference. Email us at bcastro[at]phrusa[dot]org and set up an appointment today!

  Meeting Request Letter

  Meeting Report Form

  Global HEALTH Act Fact Sheet

Every year, PHR’s National Student Program works with chapters across the country to organize and lead a Global Health Week of Action (GHWA). The GHWA is an opportunity to educate your campus about global health and encourage your colleagues to act on their new knowledge to make a difference.

Check out the new GHWA Toolkit for more information.

This year we’re encouraging chapters to focus their GHWA on the global health workforce crisis and the 2010 Global HEALTH Act, which will be introduced soon in the House of Representatives. You can raise awareness about the need for more health workers and better health systems in developing countries, and then take steps to address that need.

The first step: set your Global Health Week of Action date. Because April 7, 2010, is World Health Day, April 4-10 is the official week of action date. If you need to move the date because of spring break or campus calendars, go for it – just try to stay within 2-3 weeks of this date.

Please refer to the GHWA Toolkit to find resources for planning a successful week of events! The Toolkit includes an Issue and Action Guide, ideas for great events, suggestions on how to fundraise and publicize, and resources to share with your community.

We hope these resources – along with your creativity, energy, and education and advocacy skills – will help ensure that your GHWA has real impact.

Want more support? That’s what we’re here for. Email Hope O’Brien anytime at hobrien[at]phrusa[dot]org.

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PHR News Updates

Check out the latest news from Physicians for Human Rights:

Also, you can set up a Kaiser Health News personal RSS account to regularly receive major health care news stories.

PHR is currently seeking student volunteers able to translate French to English to assist in PHR’s involvement with the Health Workforce Advocacy Initiative (HWAI). HWAI, whose secretariat is hosted at PHR, is a civil society-led network affiliated with the Global Health Workforce Alliance.

HWAI has recently initiated a 61-country survey to help address the global health worker shortage. This survey was developed to help PHR and its partners determine how they can most effectively work with the Global Fund to facilitate Health Workforce and Health Systems Strengthening (HSS) related efforts. PHR’s aim is to increase the number and overall quality of successful Global Fund proposals.

Since we don’t know how many responses we will receive from French respondents, we can’t predict how much translating will be required. As such, we are seeking a small team of bi-lingual French and English speakers who can be called upon on as needed.

If you’re interested in being a part of this team, please contact Eric Williams at ewilliams[at]phrusa[dot]org.

Note: We are strictly looking for those who speak and read French and English at an advanced-level.

Every 9.5 minutes there is one new HIV infection in the US and forty-five new infections worldwide. This is unacceptable.

Earlier today, I joined a group of medical students, health professionals and other concerned citizens to rally for increased funding for HIV/AIDS programs in the US and around the world.

1-2-3-4, AIDS funding, we want more

we chanted while marching toward the Massachusetts State Capitol Building.

5-6-7-8, AIDS funding cannot wait.

And that’s when the torrential rain began. The group clustered together, juggling signs and umbrellas while continuing to chant. We only paused the chanting to take out our cell phones for a group call to Congressional leaders.

This week, Congressional appropriators are in the process of setting funding levels for global and domestic HIV/AIDS programs. Levels under consideration are drastically short of what is needed to fulfill US commitments to fight AIDS at home and abroad. We are already hearing about cutbacks from our partners in Uganda and we must act now to ensure that critical programs are fully funded. The Senate Appropriations Committee is schedule to consider global AIDS funding levels tomorrow, Wednesday, July 8.

President Obama’s new global health initiative calls for $63 billion over six years for all global health programs. Physicians for Human Rights estimates that the HIV/AIDS, TB and Malaria programs supported by PEPFAR alone need at least $60 billion over six years. PHR also estimates that a total of at least $95 billion over six years is needed for all of the global health initiatives outlined in President Obama’s plan and to meet all US global health commitments. We have the resources and the responsibility. We don’t have to choose between HIV/AIDS programs and other global health initiatives.

The rally is part of a coordinated effort of dozens of HIV/AIDS advocacy organizations across the country calling on leaders in Congress to strengthen US commitments to HIV/AIDS prevention and treatment programs. From June 30-July 7, activists have called upon Senate Majority Leader Harry Reid (D-NV) and Speaker of the House Nancy Pelosi (D-CA) to increase funding levels. The event today in Boston was co-sponsored by Physicians for Human Rights, the American Medical Student Association, Our Bodies, Ourselves and Health Care for All.

The rally ended with one last round of chanting and a rousing group cheer. As our group began to disperse, the rain stopped and the sun came out.

You can join our efforts today by calling on Congress to fully fund HIV/AIDS programs. Pick up your phone and call Senator Reid, Speaker of the House Pelosi, and members of the Senate Appropriations Committee.

(Cross-posted on Health Rights Advocate)

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The East African Student Health and Human Rights Leadership Institute was kicked off with a keynote by Uganda’s Minister of Health, the Honorable Stephen Malinga. He expressed his passion for medicine, which he called a priesthood. Dr. Malinga spoke of incorporating a health and human rights framework in Uganda in order protect marginalized populations. This remains particularly important because Uganda had many human rights violations under Idi Amin.

Dr. Malinga highlighted many of the problems in Uganda’s health sector, describing the health worker shortage and explaining how better pay and conditions entice health professionals to other nations in Africa or across the globe. He emphasized that health professionals need to be paid a good salary. The average salary for a Ugandan doctor is about 500,000 shillings a month (about $250), and this amount is not enough for physicians to make ends meet. He said doctors should be paid 1-2 million shillings a month. Dr. Malinga also described a need for better infrastructure and hospitals to improve working conditions and patient care.

The Health Minister also spoke of an underfunded health budget consisting of 9.6% of national budget, when 13.2% is the recommended minimum. He lamented a too-great reliance on foreign funds. Though Dr. Malinga did not mention this, there is a history of corrupt leaders and organizations mismanaging health funds intended for the sick and poor. In 2005, the Global Fund to Fight AIDS, Tuberculosis, and Malaria withdrew its grants because of misappropriation of billions of shillings. An ex-Ugandan health minister, Jim Muhwezi, is currently being investigated over embezzlement allegations linked to mismanagement of Global Fund monies.

Dr. Malinga mentioned that Uganda also needs more money for medicines.

The situation is very serious. There have been out-of-stocks of essential medicines documented as early as October last year. Only last month did the media pick up on this situation. The Action Group for Health, Human Rights, and HIV/AIDS, which worked with PHR and student leaders to organize the leadership institute, played a pivotal role in the Stop Stock-Outs Campaign that brought the issue to the forefront. As Dr. Malinga briefly mentioned needing more money for medicines, we passed around one of the national newspapers that had published Justin List’s press statement that day.

In the afternoon, each nation’s delegation presented on health and human rights challenges facing their country. The drug shortage, lack of affordable or available vaccinations for health professionals and gender inequality were some of the major issues the students currently face in their health sectors. We spent time sharing challenges and opportunities for health rights advocacy.

A theme Dr. Malinga hinted about was carried on throughout the entire conference. That is, that health care is a noble profession, a calling. Of all people, health professionals should be dedicated to a health and human rights framework of thinking and acting, so they may use their power to protect the underprivileged. If we incorporate such a framework into our local action, we’ll also be best equipped to support each other globally.

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Why Human Rights?

Is healthcare a right? What is a human right? Why is this important in Africa? Wednesday was spent meeting people who offered different perspectives on these questions and elucidated new ideas for progress in Uganda.

This is a country rife with the denial of basic rights. From a lack of educational opportunities for  youth to food insecurity in the rural areas to widespread abductions of children by the Lord’s Resistance Army (LRA) in the north?—?denial of rights is widespread.

In America, we rarely think about human rights, and most of us don’t really even know what they are. But here, in Uganda, people are acutely aware of them. The lack of rights is so severe that it affects daily life. Access to food may be a human right, but if the soil is too poor to grow anything, then how can that right be assured? If water sources are running dry due to climate change, then how can the right to water be fulfilled? These are basic life necessities that are lacking in parts of Uganda, and the rights-based approach can empower the people to demand that they have access to these things. It is up to the governing powers, however, to build sustainable systems for delivery of basic rights.

As enshrined in the Universal Declaration of Human Rights of 1948, healthcare is one of those basic human rights. In Uganda, there are so few doctors being trained, and even fewer choose to stay on here after their schooling is over. Brain drain to industrialized nations has crippled this country’s ability to effectively respond to the healthcare needs of this country, from basic primary care and obstetrics to a burgeoning HIV/AIDS epidemic. It really falls on the government here to encourage doctors to stay; one way they could do so is by paying them more adequately.

Throwing money at the problem is not the most effective solution in a country that has serious problems with corruption, accountability and rule of law. Uganda has developed a bad reputation for mismanaging aid money, as evidenced by the recent withdrawal of Global Fund for AIDS, TB and Malaria. This has led to increased hesitancy by international donors to give money. As a consequence, there are no drugs left here to treat TB, and this country has the 15 highest disease burden in the world.

Before money can simply be channeled into the system, it must be ensured that an accountable and transparent government exists and is kept in check by the people. Civil society involvement is essential, and that is why all of these human rights groups who we visited on Wednesday exist. People need to know what their rights are and that they must exercise them by voting and holding the government accountable if they want anything to change.

(Cross-posted on Health Rights Advocate)