Global Health Donors Research Articles

How feasible is it to mobilize $31 billion a year for pandemic preparedness and response? An economic growth modelling analysis

BackgroundCovid-19 has reinforced health and economic cases for investing in pandemic preparedness and response (PPR). The World Bank and World Health Organization (WHO) propose that low- and middle-income governments and donor countries should invest $31.1 billion each year for PPR. We analyse, based on the projected economic growth of countries between 2022 and 2027, how likely it is that low- and middle-income country governments and donors can mobilize the estimated funding.MethodsWe modelled trends in economic growth to project domestic health spending by low- and middle-income governments and official development assistance (ODA) by donors for years 2022 to 2027. We modelled two scenarios for countries and donors – a constant and an optimistic scenario. Under the constant scenario we assume that countries and donors continue to dedicate the same proportion of their health spending and ODA as a share of gross domestic product (GDP) and gross national income (GNI), respectively, as they did during baseline (the latest year for which data are available). In the optimistic scenario, we assume a yearly increase of 2.5% in health spending as a share of GDP for countries and ODA as a share of GNI for donors.FindingsOur analysis shows that low-income countries would need to invest on average 37%, lower-middle income countries 9%, and upper-middle income countries 1%, of their total health spending on PPR each year under the constant scenario to meet the World Bank WHO targets. Donors would need to allocate on average 8% of their total ODA across all sectors to PPR each year to meet their target.ConclusionsThe World Bank WHO targets for PPR will not be met unless low- and middle-income governments and donors spend a much higher share of their funding on PPR. Even under optimistic growth scenarios, low-income and lower-middle income countries will require increased support from global health donors. The donor target cannot be met using the yearly increase in ODA under any scenario. If the country and donor targets are not met, the highest-impact health security measures need to be prioritized for funding. Alternative sources of PPR financing could include global taxation (e.g., on financial transactions, carbon, or airline flights), cancelling debt, and addressing illicit financial flows. There is also a need for continued work on estimating current PPR costs and funding requirements in order to arrive at more enduring and reliable estimates.

Exploring equity in global health collaborations: a qualitative study of donor and recipient power dynamics in Liberia

IntroductionGlobal health collaborations between individuals from high-resource and low-resource settings are complex and often built on hierarchical structures and power differentials that are difficult to change. There have been many...

Why cost-effectiveness thresholds for global health donors should differ from thresholds for Ministries of Health (and why it matters).

Healthcare cost-effectiveness analysis is increasingly used to inform priority-setting in low- and middle-income countries and by global health donors. As part of such analyses, cost-effectiveness thresholds are commonly used to determine what is, or is not, cost-effective. Recent years have seen a shift in best practice from a rule-of-thumb 1x or 3x per capita GDP threshold towards using thresholds that, in theory, reflect the opportunity cost of new investments within a given country. In this paper, we observe that international donors face both different resource constraints and opportunity costs compared to national decision-makers. Hence, their perspective on cost-effectiveness thresholds must be different. We discuss the potential implications of distinguishing between national and donor thresholds and outline broad options for how to approach setting a donor-perspective threshold. Further work is needed to clarify healthcare cost-effectiveness threshold theory in the context of international aid and to develop practical policy frameworks for implementation.

Less stunted? The impact of Chinese health aid on child nutrition

Despite the increasing recognition of China's role as a global health donor, particularly in Africa, few studies have explored its effectiveness. We geographically matched project-level aid data from AidData with household survey data from Demographic and Health Surveys across eight African countries to examine the effect of Chinese health aid on the nutritional status of children in recipient countries. In addition to adopting a spatiotemporal identification strategy, we also included mother fixed-effects to examine variations among siblings who were exposed to Chinese health aid projects at different times. The empirical results consistently indicated that children living adjacent to Chinese health aid projects had a better nutritional status. The treatment effect of Chinese health aid projects is heterogeneous across household characteristics, types, and sectors of aid projects. Finally, vaccination may serve as a mechanism linking Chinese health aid and child nutrition in the treatment areas of recipient countries.

Strategic donor behaviour and country vulnerability in health aid transitions

BackgroundWhen countries reach the middle-income threshold, many multilateral donors, including Gavi, the Vaccine Alliance (Gavi), begin to withdraw their official development assistance (ODA), known as graduation. We hypothesised that bilateral...

Why cost-effectiveness thresholds for global health donors differ from thresholds for Ministries of Health (and why it matters)

Healthcare cost-effectiveness analysis is increasingly used to inform priority-setting in low- and middle-income countries and by global health donors. As part of such analyses, cost-effectiveness thresholds are commonly used to determine what is, or is not, cost-effective. Recent years have seen a shift in best practice from a rule-of-thumb 1x or 3x per capita GDP threshold towards using thresholds that, in theory, reflect the opportunity cost of new investments within a given country. In this paper, we observe that international donors face both different resource constraints and opportunity costs compared to national decision makers. Hence, their perspective on cost-effectiveness thresholds must be different. We discuss the potential implications of distinguishing between national and donor thresholds and outline broad options for how to approach setting a donor-perspective threshold. Further work is needed to clarify healthcare cost-effectiveness threshold theory in the context of international aid and to develop practical policy frameworks for implementation.

Conditions required for the artificial-intelligence-based computer-aided detection of tuberculosis to attain its global health potential

In 2021, WHO issued a novel recommendation within its tuberculosis screening guidelines: the approval of artificial-intelligence-based computer-aided detection (AI-CAD) to analyse chest x-rays for tuberculosis detection in place of human readers.1 The recommendation was largely based on evidence suggesting that the accuracy of AI-CAD approximates that of radiologists in identifying tuberculosis on chest x-rays.1 Global health donors and actors working to eradicate tuberculosis regard AI-CAD as an important tool for finding the so-called missing millions of people with active tuberculosis that is left undetected each year.

The impacts of donor transitions on health systems in middle-income countries: a scoping review.

As countries graduate from low-income to middle-income status, many face losses in development assistance for health and must ‘transition’ to greater domestic funding of their health response. If improperly managed, donor transitions in middle-income countries (MICs) could present significant challenges to global health progress. No prior knowledge synthesis has comprehensively surveyed how donor transitions can affect health systems in MICs. We conducted a scoping review using a structured search strategy across five academic databases and 37 global health donor and think tank websites for literature published between January 1990 and October 2018. We used the World Health Organization health system ‘building blocks’ framework to thematically synthesize and structure the analysis. Following independent screening, 89 publications out of 11 236 were included for data extraction and synthesis. Most of this evidence examines transitions related to human immunodeficiency virus/Acquired Immune Deficiency Syndrome (AIDS; n = 45, 50%) and immunization programmes (n = 14, 16%), with a focus on donors such as the Global Fund to Fight AIDS, Tuberculosis and Malaria (n = 26, 29%) and Gavi, the Vaccine Alliance (n = 15, 17%). Donor transitions are influenced by the actions of both donors and country governments, with impacts on every component of the health system. Successful transition experiences show that leadership, planning, and pre-transition investments in a country’s financial, technical, and logistical capacity are vital to ensuring smooth transition. In the absence of such measures, shortages in financial resources, medical product and supply stock-outs, service disruptions, and shortages in human resources were common, with resulting implications not only for programme continuation, but also for population health. Donor transitions can affect different components of the health system in varying and interconnected ways. More rigorous evaluation of how donor transitions can affect health systems in MICs will create an improved understanding of the risks and opportunities posed by donor exits.

Commodities of Care: The Business of HIV Testing in China by Elsa L. Fan

Reviewed by: Commodities of Care: The Business of HIV Testing in China by Elsa L. Fan Aaron Su Elsa L. Fan. Commodities of Care: The Business of HIV Testing in China. Minneapolis: University of Minnesota Press, 2021. 216 pp. When strategies to streamline global health resources result in narrow, magic-bullet testing solutions, what meaningful interventions and social relations are enacted or foreclosed? Resonating with contemporary debates around the limits of technical solutions for COVID-19, Elsa L. Fan's Commodities of Care explores the scaling up of HIV testing in China stimulated by global health donors through programs of performance-driven financing. From the production of the category "men who have sex with men" (MSM) to the retraction of programs that offer lasting support beyond the positive test itself, Commodities of Care deftly illustrates how new trends in global health financing simultaneously usher in new subject positions, experiences of disease, and definitions of care. In so doing, the book offers a lucid glimpse into the stories and meanings of HIV for MSM in China while never losing sight of the political economy that makes these experiences possible. Commodities of Care is the result of Fan's comparative ethnographic work across several HIV organizations in a southern Chinese city. These community-based local centers, such as Bright Love, administer sexual health services as well as events and outreach programs, yet their funding structures are ambivalently tied to heterogeneous global health donors. Some, like the Health Fund and the Global Fund, have recently pushed for performance-based financing schemes that determine payments based on quantitative measures of HIV tests administered, positive test outcomes, and other related outputs, thereby reducing care to the transactional process of "selling blood (mai xue)" (3), as one of Fan's interlocutors [End Page 715] describes it. Analyzing the consequences of this shift—e.g., the purposeful proliferation of repeated and fraudulent tests for financial gain (40), the reduction of the HIV-positive population to solely MSM (17), and the "instrumentalization of community-based organizations as technical service delivery agents rather than stewards of social change" (116)—the author illuminates the transformative effects that "audit cultures" (Strathern 2000) can wield in the making of local and global health. Having worked in the development and philanthropy industries during these "ideological shifts" (19), Fan is uniquely positioned to tell the history of global health's financial streamlining at the turn of the millennium alongside the emergence of new players like the Gates Foundation. In the introduction and Chapter 1, she ethnographically analyzes how the world of HIV testing as a singular global health solution par excellence comes together in the Chinese context. Intricately describing the promotion of performance-based financing over peer-to-peer education (26) as well as the rise of statistics like the quality-adjusted life year and disability-adjusted life year in global health discourses (36), Fan traces how these shifts appear in the narrations and material practices of her interlocutors. For example, she digs into rumors of organizations splitting performance incentives with non-MSM migrant laborers, whom they recruit to get tested for the sake of their tally. She thus reveals the concrete, local consequences of approaches like evidence-based medicine (EBM) and their dominance in public health. In Chapter 2, Fan draws on Ian Hacking's (1986) concept of "making up people"–the production of new subject positions through categories and counting practices–to show how global health's enumeration strategies led to the "making up" of MSM in China. She charts the varied negotiations over the concept of MSM in China to understand organizations' concerns about recruiting testers, noting that many MSM were perhaps in publicly heterosexual relationships. Addressing this problem of a "hidden population" and insisting that Chinese MSM could not merely be drawn out and defined in the conventional terms of identity politics, Fan illuminates how practices of self-affirmation (ziworentong) "instill in these men an acceptance of their same-sex desires and a recognition of their HIV risk as part and parcel of desires" (77). The result of this affirmation, Fan reminds us, is not just the production of new personhoods but also the manufacturing of "commodities of care" in...

The U.S. Global Gag Rule in Ethiopia: a foreign policy challenging domestic sexual and reproductive health and rights gains

BackgroundEthiopia’s government and civil society have driven crosscutting initiatives in the last 15 years to improve sexual and reproductive health outcomes, including passing a 2005 abortion law that facilitated reduced rates of maternal death due to unsafe abortion. However, both the government and nongovernmental organizations have relied on external funding for sexual and reproductive health and rights, particularly from the U.S. government, which has been Ethiopia’s largest global health donor. This article explores how the implementation and expansion of the 2017–2021 U.S. foreign policy “Protecting Life in Global Health Assistance,” also known as the Global Gag Rule—which attached itself to a nongovernmental organization’s funding—impacted sexual and reproductive health and rights, including safe abortion care, in Ethiopia.MethodsThis article is based on research conducted by PAI staff in Ethiopia in 2018 with follow-up in 2019. PAI held in-depth semistructured interviews with representatives of 30 organizations in Ethiopia’s capital, Addis Ababa. Among these groups were U.S.-based and non-U.S. nongovernmental organizations, including community-based organizations, non-U.S. government donors, and Ethiopian government officials.ResultsNongovernmental organizations have been essential to sexual and reproductive health service provision and advocacy in Ethiopia. Because of the sector’s reliance on U.S. global health assistance, these organizations; their activities; and, consequently, the wider health system were negatively impacted by the Global Gag Rule. Certain vulnerable groups, particularly adolescents and youth, have traditionally relied on the private sector for sexual and reproductive health services. PAI’s research demonstrates that U.S. policy disrupted activities and service delivery, threatened the closure of private clinics, stalled mobile outreach, and impacted safe abortion training of health personnel. Additionally, the Global Gag Rule dismantled partnerships, affected non-U.S. government donors’ investments, and caused confusion that limited activities permissible under the policy.ConclusionsThe Trump administration’s Global Gag Rule forced non-U.S. organizations to choose between providing comprehensive care or losing U.S. global health assistance, ultimately impacting populations in need of services. Ethiopia provides a clear example of how the Global Gag Rule can threaten a country’s domestic health agenda by targeting nongovernmental organizations that are vital to health service delivery and safe abortion care.

Competing Responses to Global Inequalities in Access to COVID Vaccines: Vaccine Diplomacy and Vaccine Charity Versus Vaccine Liberty.

Global access to coronavirus vaccines has been extraordinarily unequal and remains an ongoing source of global health insecurities from the evolution of viral variants in the bodies of the unvaccinated. There have nevertheless been at least 3 significant alternatives developed to this disastrous bioethical failure. These alternatives are reviewed in this article in the terms of “vaccine diplomacy,” “vaccine charity,” and “vaccine liberty.” Vaccine diplomacy includes the diverse bilateral deliveries of vaccines organized by the geopolitical considerations of countries strategically seeking various kinds of global and regional advantages in international relations. Vaccine charity centrally involves the humanitarian work of the global health agencies and donor governments that have organized the COVAX program as an antidote to unequal access. Despite their many promises, however, both vaccine diplomacy and vaccine charity have failed to deliver the doses needed to overcome the global vaccination gap. Instead, they have unfortunately served to immunize the global vaccine supply system from more radical demands for a “people’s vaccine,” technological transfer, and compulsory licensing of vaccine intellectual property (IP). These more radical demands represent the third alternative to vaccine access inequalities. As a mix of nongovernmental organization-led and politician-led social justice demands, they are diverse and multifaceted, but together they have been articulated as calls for vaccine liberty. After first describing the realities of vaccine access inequalities, this article compares and contrasts the effectiveness thus far of the 3 alternatives. In doing so, it also provides a critical bioethical framework for reflecting on how the alternatives have come to compete with one another in the context of the vaccine property norms and market structures entrenched in global IP law. The uneven and limited successes of vaccine diplomacy and vaccine charity in delivering vaccines in underserved countries can be reconsidered in this way as compromised successes that not only compete with one another, but that have also worked together to undermine the promise of universal access through vaccine liberty.

Making the Final Decade of the Sustainable Development Goals Count: An Analysis of Donors’ Subnational Approaches to Reaching the Poorest People

Although the proportion of the world’s population living in poverty has declined substantially over the last two decades, the absolute number of people that live in poverty or vulnerable conditions has remained high. Nearly 70% of the poor now live in countries classified as middle-income.3 We conducted a document review and comparative analysis of six of the largest global health donors to better understand the extent to which they incorporate subnational poverty into their allocation decisions and programming. The donors we studied were Gavi, the Vaccine Alliance (Gavi); the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund); the President’s Emergency Plan for AIDS Relief (PEPFAR); the United States Agency for International Development (USAID)—specifically, its Global Health Bureau; the World Bank’s International Development Association (IDA); and the Government of Japan. We found that most donor high-level strategy documentation allude to the relationship between poverty and health by, for example, noting the financial burden of specific diseases targeted or the disproportionate disease burdens that may fall on the poorest people. However, only two of these donors, Gavi and IDA, incorporate any subnational poverty indicators or broader subnational poverty focus that could be tracked and monitored over time. Gavi and IDA also integrate household level wealth or health expenditure data in their routine monitoring processes, though there is limited information about how much this integration influences how these two donors target aid toward the poorest communities. For the other four donors—Global Fund, PEPFAR, USAID, and Japan—subnational poverty is either not addressed or else is invoked in the context of other social or demographic factors that make certain groups of people vulnerable to disease (e.g., sex workers’ vulnerability to HIV).

Challenges and Opportunities in China\u2019s Health Aid to Africa: Findings from Qualitative Interviews in Tanzania and Malawi

BackgroundChina has played an increasing role in development aid across Africa. Most recently, China has increased its external investments through the Belt and Road Initiative, China’s signature infrastructure and trade drive to link China to Asia and Africa. This is likely to result in continuing growth of China’s investment in health in sub Saharan Africa. While conflicting opinions have been raised regarding the motivation and value of these investments, few data have been solicited from those directly involved in China-Africa health aid. We conducted a qualitative study to collect information on perceptions and opinions regarding Chinese-supported health related activities in Africa through in-depth interviews among local African and Chinese participants in Malawi and Tanzania.ResultsOur findings reveal shared experiences and views related to challenges in communication; cultural perspectives and historical context; divergence between political and business agendas; organization of aid implementation; management and leadership; and sustainability. Participants were broadly supportive and highly valued Chinese health aid. However, they also shared common insights that relate to challenging coordination between China and recipient countries; impediments to communication between health teams; and limited understanding of priorities and expectations. Further, they share perspectives about the need for shaping the assistance based on needs assessments as well as the importance of rigorous reporting, and monitoring and evaluation systems.SummaryOur findings suggest that China faces similar challenges to those experienced by other longstanding development aid and global health donors. As it continues to expand cooperation across Africa and other regions, it will be important for China to consider the issues identified through our study to help inform collaborative and effective global health assistance programs. The insights garnered from this research are not only relevant to China’s engagement in Africa but for other global health assistance donors as well.

The ethical case for global measles eradication-justice and the Rule of Rescue.

Measles causes a substantial disease burden for all countries, while mortality is greatest in underserved, marginalized populations. Global measles eradication is feasible and the strategies critically rely upon well-functioning national immunisation programs and surveillance systems. All six regions of the World Health Organisation have adopted measles elimination targets. The Rule of Rescue and the principle of justice leave no ethical place for health programs, governments, global public health bodies or donors to hide if they impede efforts to eradicate measles globally by not taking all necessary actions to establish a global eradication target and committing the resources essential to achieve this goal.

Transitioning Away from Donor Funding for Health: A Cross Cutting Examination of Donor Approaches to Transition

Many donors are reconsidering their approach to providing health aid to countries that are viewed as becoming increasingly capable of self-financing their own development. To better understand this phenomenon, we analyzed the transition approaches adopted by six key global health donors, three multilateral and three bilateral, who provided nearly 75% of all disbursed official development assistance for health in 2016. We conducted a desk-based review and triangulated our findings with semi-structured key informant interviews. We found: 1) there is no consensus on the terminology used to describe the transition process; 2) donors vary in terms of the formality of their policies, the indicators used to allocate resources and/or trigger transition, and the timeline/duration of transition; 3) some donors view the unit of transition at the sector or program level rather than the country level; and 4) donors provide varying degrees of support before, during, and after transition. Our findings suggest that more explicit transition approaches and greater definitional clarity are needed. Donors should avoid a “one size fits all” approach—a lack of flexibility puts countries at risk. Evidence should be generated and shared on which transition modalities work best and under which circumstances. Donors should communicate with each other and avoid transitioning at the same time. As more low-income countries transition to middle-income status, transitions away from donor support for health will become an increasingly important phenomenon to understand.

Theory and practice of social norms interventions: eight common pitfalls

BackgroundRecently, Global Health practitioners, scholars, and donors have expressed increased interest in “changing social norms” as a strategy to promote health and well-being in low and mid-income countries (LMIC). Despite this burgeoning interest, the ability of practitioners to use social norm theory to inform health interventions varies widely.Main bodyHere, we identify eight pitfalls that practitioners must avoid as they plan to integrate a social norms perspective in their interventions, as well as eight learnings. These learnings are: 1) Social norms and attitudes are different; 2) Social norms and attitudes can coincide; 3) Protective norms can offer important resources for achieving effective social improvement in people’s health-related practices; 4) Harmful practices are sustained by a matrix of factors that need to be understood in their interactions; 5) The prevalence of a norm is not necessarily a sign of its strength; 6) Social norms can exert both direct and indirect influence; 7) Publicising the prevalence of a harmful practice can make things worse; 8) People-led social norm change is both the right and the smart thing to do.ConclusionsAs the understanding of how norms evolve in LMIC advances, practitioners will develop greater understanding of what works to help people lead change in harmful norms within their contexts. Awareness of these pitfalls has helped several of them increase the effectiveness of their interventions addressing social norms in the field. We are confident that others will benefit from these reflections as well.

Projected Health Financing Transitions: Timeline and Magnitude

In recent years, many global health institutions have adopted eligibility and transition frameworks for the countries they support, generating questions about how these frameworks apply in practice—and whether global health progress will be put at risk through premature or poorly planned transition processes. This paper builds on previous work in this space by mapping an indicative timeline of transition through 2040 across five global health financing mechanisms—Gavi, the Vaccine Alliance (Gavi); the Global Fund to Fight AIDS, Tuberculosis, and Malaria (the Global Fund); the World Bank’s International Development Association (IDA); the Global Polio Eradication Initiative (GPEI); and the US President’s Emergency Plan for AIDS Relief (PEPFAR)—with granularity by year and stage of transition. It contextualizes the magnitude of fiscal transition for each country with reference to overall government expenditure on health. Finally, it identifies countries and specific time periods of high transition risk based on cumulative fiscal impact. By 2040, it finds that Gavi and IDA will each see major transformations of their funding portfolios, while few large or aid-dependent countries will transition from Global Fund support. The countries in most fiscal jeopardy from anticipated transition are not those “transitioning” based on GDP per capita or disease burden, but instead those that are likely to be impacted by the near-term winddown of GPEI and reallocations of PEPFAR financing. A handful of countries face many major transitions within a very narrow time window—and the cumulative fiscal effect may be substantial, even if each individual transition should be manageable. Global health donors should build upon these results, working cooperatively at the country level, to ensure countries have a realistic understanding of transition processes to enable appropriate planning, budgeting, and prioritization.

Communications, Immunization, and Polio Vaccines: Lessons From a Global Perspective on Generating Political Will, Informing Decision-Making and Planning, and Engaging Local Support.

The requirements under objective 2 of the Polio Eradication and Endgame Strategic Plan 2013–2018—to introduce at least 1 dose of inactivated poliomyelitis vaccine (IPV); withdraw oral poliomyelitis vaccine (OPV), starting with the type 2 component; and strengthen routine immunization programs—set an ambitious series of targets for countries. Effective implementation of IPV introduction and the switch from trivalent OPV (containing types 1, 2, and 3 poliovirus) to bivalent OPV (containing types 1 and 3 poliovirus) called for intense global communications and coordination on an unprecedented scale from 2014 to 2016, involving global public health technical agencies and donors, vaccine manufacturers, World Health Organization and United Nations Children’s Fund regional offices, and national governments. At the outset, the new program requirements were perceived as challenging to communicate, difficult to understand, unrealistic in terms of timelines, and potentially infeasible for logistical implementation. In this context, a number of core areas of work for communications were established: (1) generating awareness and political commitment via global communications and advocacy; (2) informing national decision-making, planning, and implementation; and (3) in-country program communications and capacity building, to ensure acceptance of IPV and continued uptake of OPV. Central to the communications function in driving progress for objective 2 was its ability to generate a meaningful policy dialogue about polio vaccines and routine immunization at multiple levels. This included efforts to facilitate stakeholder engagement and ownership, strengthen coordination at all levels, and ensure an iterative process of feedback and learning. This article provides an overview of the global efforts and challenges in successfully implementing the communications activities to support objective 2. Lessons from the achievements by countries and partners will likely be drawn upon when all OPVs are completely withdrawn after polio eradication, but also may offer a useful model for other global health initiatives.

Implementing the Synchronized Global Switch from Trivalent to Bivalent Oral Polio Vaccines-Lessons Learned From the Global Perspective.

In 2015, the Global Commission for the Certification of Polio Eradication certified the eradication of type 2 wild poliovirus, 1 of 3 wild poliovirus serotypes causing paralytic polio since the beginning of recorded history. This milestone was one of the key criteria prompting the Global Polio Eradication Initiative to begin withdrawal of oral polio vaccines (OPV), beginning with the type 2 component (OPV2), through a globally synchronized initiative in April and May 2016 that called for all OPV using countries and territories to simultaneously switch from use of trivalent OPV (tOPV; containing types 1, 2, and 3 poliovirus) to bivalent OPV (bOPV; containing types 1 and 3 poliovirus), thus withdrawing OPV2. Before the switch, immunization programs globally had been using approximately 2 billion tOPV doses per year to immunize hundreds of millions of children. Thus, the globally synchronized withdrawal of tOPV was an unprecedented achievement in immunization and was part of a crucial strategy for containment of polioviruses. Successful implementation of the switch called for intense global coordination during 2015–2016 on an unprecedented scale among global public health technical agencies and donors, vaccine manufacturers, regulatory agencies, World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) regional offices, and national governments. Priority activities included cessation of tOPV production and shipment, national inventories of tOPV, detailed forecasting of tOPV needs, bOPV licensing, scaling up of bOPV production and procurement, developing national operational switch plans, securing funding, establishing oversight and implementation committees and teams, training logisticians and health workers, fostering advocacy and communications, establishing monitoring and validation structures, and implementing waste management strategies. The WHO received confirmation that, by mid May 2016, all 155 countries and territories that had used OPV in 2015 had successfully withdrawn OPV2 by ceasing use of tOPV in their national immunization programs. This article provides an overview of the global efforts and challenges in successfully implementing this unprecedented global initiative, including (1) coordination and tracking of key global planning milestones, (2) guidance facilitating development of country specific plans, (3) challenges for planning and implementing the switch at the global level, and (4) best practices and lessons learned in meeting aggressive switch timelines. Lessons from this monumental public health achievement by countries and partners will likely be drawn upon when bOPV is withdrawn after polio eradication but also could be relevant for other global health initiatives with similarly complex mandates and accelerated timelines.

Geographic information system for improving maternal and newborn health: recommendations for policy and programs

This correspondence argues and offers recommendations for how Geographic Information System (GIS) applied to maternal and newborn health data could potentially be used as part of the broader efforts for ending preventable maternal and newborn mortality. These recommendations were generated from a technical consultation on reporting and mapping maternal deaths that was held in Washington, DC from January 12 to 13, 2015 and hosted by the United States Agency for International Development’s (USAID) global Maternal and Child Survival Program (MCSP). Approximately 72 participants from over 25 global health organizations, government agencies, donors, universities, and other groups participated in the meeting.The meeting placed emphases on how improved use of mapping could contribute to the post-2015 United Nation’s Sustainable Development Goals (SDGs), agenda in general and to contribute to better maternal and neonatal health outcomes in particular. Researchers and policy makers have been calling for more equitable improvement in Maternal and Newborn Health (MNH), specifically addressing hard-to-reach populations at sub-national levels. Data visualization using mapping and geospatial analyses play a significant role in addressing the emerging need for improved spatial investigation at subnational scale. This correspondence identifies key challenges and recommendations so GIS may be better applied to maternal health programs in resource poor settings. The challenges and recommendations are broadly grouped into three categories: ancillary geospatial and MNH data sources, technical and human resources needs and community participation.