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  • AACOCF3 The long term goal of independence of

    2019-06-21

    The long-term goal of independence of recipients and sustainability of projects must remain at the forefront of all programmes. The post-2015 Sustainable Development Goals (SDGs) have been criticised as being too general and impractical, and as we move into the SDG era this study has identified a need for new funding pathways related to RMNCH. Here is a dilemma: the most important aspect of the SDG era is not only a chance for the global health AACOCF3 to work together, but also the opportunity to connect sectors. This would include a possible move from currently dominant project-oriented funding to health system strengthening in which delivery of RMNCH services should be essential. Greater efforts are also needed to prevent donor aid from displacing national funding for programmes, and governments of developing countries must be more involved in global health initiatives, but such involvement and planning needs detailed and robust analysis. A wealth of studies exists for tracking ODA, but few go into any depth to analyse the linkages between ODA and outcomes or effectiveness. The article by Arregoces and colleagues explores this area through its analysis of the relation between ODA+ on RMNCH and health outcomes in child mortality and other related health outcomes. This analysis leads the way for further research to be done to link more directly to outcomes, and to find innovative ways to analyse relations between programme funding, national funding, and delivery metrics. It also supports further development of more comprehensive and detailed tracking of resources through a health accounting framework.
    The revised International Health Regulations (IHR) entered into force on June 15, 2007, obligating (now) 196 States Parties to detect, assess, report, and respond to potential public health emergencies of international concern (PHEIC) at all levels of government, and to report such events rapidly to the WHO to determine whether a coordinated, global response is required. In the 8 years since its entry into force, there have been three declared PHEIC, including pandemic influenza H1N1 in 2009, re-emerging wild-type poliovirus in April, 2014, Ebola virus disease in west Africa in August, 2014, and the emergence of new diseases such as Middle East respiratory syndrome coronavirus and influenza H7N9, with still uncertain risks to global population health.
    It is now just more than a year since the official confirmation of an outbreak of Ebola haemorrhagic fever in west Africa. With new cases occurring at their lowest rate for 2015, and the end of the outbreak in sight for all three countries predominantly affected, now is the time to consider strategies to prevent future outbreaks of this, and other, zoonotic pathogens. The Ebola outbreak, like many other emerging diseases, illustrates the crucial role of the ecological, social, political, and economic context within which diseases emerge. Increasing anthropogenic environmental changes, coupled with a globalised network of travel and trade, allow zoonotic pathogens to spill over into human beings with increasing frequency, and leave us supremely vulnerable to their international spread. Pandemics are no longer simply the domain of public health and clinical medicine, but are a social issue, a development issue, and a global security issue. The cost of management of infectious disease outbreaks is almost always greater than the cost of avoiding them. For severe acute respiratory syndrome (SARS), the global cost of a single outbreak was estimated to be between US$13 billion and US$50 billion at the currency values of the 2003 outbreak. For Ebola, the cost might be higher—both in the direct, short-term cost of control, patient care, and hospital admission, and in the indirect, longer-term dislocation of the regional economies in west Africa. The economic costs of disease emergence are projected to continue to rise in line with increasing frequency of outbreaks driven by expanding socioeconomic and environmental changes that cause diseases to emerge. Mitigation of future pandemic threats such as Ebola is therefore AACOCF3 more cost-effective than the current approach of responding to outbreaks after they have begun to spread rapidly in the human population.