Comments

Thanks Belinda for highlighting this critical but undervalued aspect of global health. One of the key errors people make when thinking about emergency care in LMICs is to imagine their local emergency department, or something they've seen on television transposed into a low resource environment. People imagine rooms full of expensive equipment and high technology interventions when they think about emergency care. But the most valuable and important aspects of safe and effective emergency care are not expensive and not complicated. Elizabeth Molyneux and colleagues illustrated this so well in their <a href="http://www.who.int/bulletin/volumes/84/4/314.pdf" rel="nofollow">study</a> on transforming a busy and poor-functioning children's outpatients clinic in Malawi. Molyneux showed that by training staff in emergency care skills, introducing some emergency care systems (such as a simple 3-scale triage system) and re-designing and renovating the environment, mortality can be substantially reduced. This is the 'staff', 'systems', 'space (and 'stuff') that Paul Farmer also talks about in his terrific <a href="http://www.lrb.co.uk/v37/n03/paul-farmer/who-lives-and-who-dies" rel="nofollow">article</a> in the London Review of Books earlier this year. None of these components are high cost or high technology. But they do require some investment in clinicians and their hospitals; neither of which have received much interest or attention in the global health discourse so far. People in poor countries need both public health interventions (sanitation, immunisations etc.) and safe and effective clinical care. A hospital or clinic that can be trusted to provide emergency care inculcates public confidence that is crucial for times of increased need. The importance of accessible and trustworthy hospitals (or lack of them) to an effective Ebola response in West Africa illustrates how critical clinical care is to a functional health system. As you have illustrated, Belinda, there is hope and movement for a more integrated approach ahead. Those of us working in the field of global emergency care welcome your article and the opportunity to discuss these critical issues with policy and thought-leaders in our region. Great work! Dr Georgina Phillips, FACEM

So you believe this lesser pay is justified?

Ensuring that disease targeted investments do not undermine investments towards other health objectives seems like common sense but proves to be less than common. The Ebola episode seemed to focus the attentions of those making investment decisions on the importance of health systems but that focus may already be dissipating. Very important to keep this at the forefront of the debate.

Many thanks for the clarification.

I WAS BORN RIGHT IN THE HEART OF GULF,KEREMA TOWN, I SPENT 17 YEARS IN MY HOME TOWN AS A KID I NEVER REALISED THE SERVICES I MISSED BUT I BELIEVE IN MY FELLOW YOUNG GENERATION,IT IS NOT THE PROBLEM IN THE GOVERNMENT OF PAPUA NEW GUINEA THAT MY PROVINCE IS WHAT IT IS NOW,RATHER IT'S TYPICAL ATTITUDE PROBLEM OR LACK OF VISION THAT MOST OF OUR LEADERS HAVE THAT IS SLOWING DOWN OUR DEVELOPMENT RATE.BEING IN A NATIONAL HIGH AND LISTENING TO STUDENTS FROM OTHER PROVINCES OPINION ABOUT MY PROVINCE ALWAYS BREAKS MY HEART,BUT NO MATTER WHAT,I AS A YOUNG SON OF GULF URGE EVERY PARENTS WHO ARE READING THIS TO PLEASE ATLEAST MAKE SURE YOUR KIDS HAVE BASIC EDUCATION,I BELIEVE THAT,HUMAN RESOURCE IS THE TOP MOST VALUED RESOURCE THAT CAN TURN THE ODDS AROUND..I FOR ONE IF IN POWER WILL DO ANYTHING AND EVERYTHING TO ENSURE THAT EVERY SINGLE SON OF GULF PROVINCE SHALL BEAR THE NAME OF THEIR PROVINCE WITH PRIDE AND THE NAME GULF SHALL BE A BLESSING TO THE WHOLE NATION. THANK YOU PROUD SON OF GULF..

Thanks Barbara - some great points. Without getting into the debate on Australian budgets, your blog also raises the issue of whether vertical programmes strengthen immunization / health systems or not. There is rhetoric and wording in polio, measles & rubella programme plans in support of strengthening immunization systems. In reality (as the agenda is driven by CDC and a disease control paradigm) budgets do not reflect this rhetoric and activities are often limited to surveillance & laboratory strengthening, and session monitoring, often not including service delivery of other routine vaccines or other MNCH interventions. Over the years, donors have paid for a massive set of assets to delivery polio vaccine, in campaign mode, to the world's children. Debate rages on whether this strengthened or weakened health systems.However the polio related assets (and lessons learned) have the potential to sustainably address inequities by delivering more than polio, measles or rubella vaccines. 20% of the world's children do not receive DTP3 vaccine and 40% remain not fully vaccinated.) The polio Independent Monitoring Board has a role to play in stimulating this thinking.

Thanks for the insights Graeme! The article is receiving positive response from social media in PNG. Regards Bal

Thanks Belinda, Re. The emergence of emergency care: You may like to see the ACEM International Emergency Medicine Network News of September 2015: https://www.acem.org.au/getattachment/f58d278a-6b1a-493e-b929-3e24d535bcb6/IEMNET-News-Vol-1-Issue-1-(1).aspx Regards, Chris Curry

Allow me to correct the record on a statement in the blog by Barbara McPake and Peter Annear on polio eradication and routine immunisation, posted on DevPolicy today. The authors state that “the additional commitment to polio eradication was thus reduced from $80 million to $36 million.” In fact Foreign Minister Bishop’s 1 June announcement committed funding for polio eradication and routine immunisation. An additional $36 million in funding is being provided to the World Bank to help strengthen routine immunisation in our region. This is being delivered as part of the Minister’s commitment. In total, therefore, $92 million of the Government’s $100 million commitment will be delivered. I also note that Nigeria was declared polio-free on 25 September this year, meaning that now only Pakistan and Afghanistan remain polio endemic. The world is making great progress towards polio eradication. Bill Costello Assistant Secretary Health and Water Branch DFAT

This is an argument against strategy. Life may be just one damn thing after another but it can only help to aim to achieve more than small increments.

There's a lot wrong with the SDGs but this article misses the biggest concerns. The SDGs don't set up new obligations for states, they are supposed to focus on how to meet existing obligations. They claim they will 'transform' the world in light of the deepening inequalities between and within countries, climate change and the death of democracy. That requires changes to the deeply inequitable global finance, trade and investment rules that ensure wealth is extracted from the Global South and channeled to a tiny minority, mostly in the the Global North. Essentially the problem with the SDGs is that they don't address wealth and neo-liberalism. If the world continues with the growth model we need to consume 175 times our current rate to lift everyone out of poverty and the meager rate of $5 per day. Instead the SDGs refer to expanded partnerships with the private sector - more of the same. (No surprises that Ambassador Ashe who presided over consultations for the SDGs as President of the GA was arrested this week on corruption charges after allegedly taking bribes to promote public-private partnerships). The week following the UN General Assembly when the goals were adopted, 12 of the member states met in the US to finalise the TPP. Unlike the SDGs the TPP is enforceable and has remedies (for corporations). The obligations the TPP establishes directly contravene the stated aims of the SDGs.

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