Archive for the ‘Funding’ Category

The Global Gag Rule, a harmful human rights violation

March 12, 2017

The Global Gag Rule (GGR) is harmful to women and families and violates human rights. Originally known as the “Mexico City Policy” because it was enacted by Ronald Reagan in 1984 at a conference in Mexico City, the policy is more commonly known as the Global Gag Rule because of how it silences NGOs and health care workers. Specifically, the original policy dictated that no USAID family planning funds could be awarded to organizations that performed or promoted abortion and therefore prohibited them from even speaking about abortion.

The GGR is highly partisan- every Democrat president since Reagan has rescinded the policy and every Republican has reinstated it. The current administration, however, has not only reinstated the GGR but has dramatically expanded the funds that are affected.

Reagan’s version applied to USAID family planning funds; G.W. Bush’s version limited the GGR by exempting USAID HIV/AIDs related work. The latest iteration, however, greatly expands the affected funds to cover all foreign aid arising from any agency or department. The current version restricts up to $9.5 billion in aid, or 16x the amount of funds that would have been affected by previous versions.

Worse yet, beyond being a clear example of religious overreach in US politics and a violation of human rights, evidence suggests that the policy reduces sex education and contraception use while increasing both abortions and the proportion of abortions that result in health complications- maternal, family, and child health all suffer. There is a large coalition of organizations that oppose the GGR. You can take action today by learning more information about the GGR and volunteering or donating to organizations like IPPF, PAI, and the Bill and Melinda Gates Foundation who, together with UN member countries, are attempting to counteract the extreme funding deficit.

Rescind the Mexico City Policy

March 12, 2017

In 1984, President Reagan instituted what has been referred to as the “Mexico City” Policy. This policy prohibits any federal funds going to NGOs that provide family planning advice related to abortion. Its intent was to ensure that no U.S. taxpayer money was spent on any abortion related services. Depending on which political party is in power, the policy is periodically reinstated and then rescinded again. Recently, President Trump reinstated the Mexico City Policy. Reinstatement of this policy is often applauded by pro-life groups and religious institutions such as the Catholic Church. Other groups, such as Planned Parenthood and Doctors Without Borders, have come out strongly against reinstating the policy.

Although this policy is intended to reduce the number of abortions by not allowing funding to go toward organizations that advise women on abortion and other family planning services, evidence indicates that the policy results in an increase in the number of abortions over time. For instance, a study cited in The Economist indicated that Sub-Saharan countries with high exposure to this policy saw dramatic increase in abortions over time after it was reinstated by the Bush Administration in 2001 (see figure below).  Since this policy explicitly deprives organizations of all funding because they provide abortions or abortion related advice, it can also reduce the amount of funding available for contraceptives, HIV testing, and prenatal care.

Credit: The Economist

In summary, The Mexico City policy is counterproductive to reducing abortion and improving women’s health services as evidence has indicated the policy results in an increase the number of abortions when federal funding for NGO’s is reduced. Therefore, it would be better for women’s health and many pro-life groups if the policy is rescinded as it deprives funding for NGOs that provide other important services like contraception and STI testing.

Rescinding the Mexico City Policy

March 12, 2017

The Mexico City Policy, also commonly known as the “Global Gag Rule,” was first introduced in 1985 during the Reagan administration and has been rescinded by most Democratic presidents and reinstated by most Republican presidents since then. This policy was most recently reinstated by President Trump, and prohibits foreign NGOs that receive US government funding from performing abortions, providing counseling and information on abortions as a method of family planning, or promoting any changes in a country’s legislation regarding abortion. The Trump administration’s reinstatement, however, does not apply only to family planning assistance. It expands to limit all U.S. global health funding, including global HIV and maternal child health (MCH) assistance.

Many organizations, including Marie Stopes International, Doctors Without Borders, Population Action International, and International Planned Parenthood Federation, have released statements in opposition to the Global Gag Rule. Foreign governments have also stepped forward, with some creating international funds or pledging money in an effort to fill the funding gap. While these are a good start, we need greater mobilization to fight for women’s health and empowerment.

Unsafe abortion is one of the main causes of maternal mortality worldwide, and disproportionately affects women in low- and middle-income countries and in vulnerable contexts such as refugee camps and conflict zones. Research has shown that policies preventing providers from educating women about abortion and family planning methods lead to more unwanted pregnancies, more unsafe abortions, and higher rates of STIs. This policy also threatens progress on many other fronts, such as HIV, child malaria, tuberculosis, and immunizations. Healthcare providers, public health professionals, and all concerned citizens need to speak out for global reproductive rights, support international aid organizations, and push Trump and US Congress for the repeal of the Mexico City Policy.

South Africa’s Never Ending Struggle with Mental Health Care

March 12, 2017

x1461868764808.jpg.pagespeed.ic.I8dCKVYwxTImage Credit: The Rand Blog

In February of 2017, over 94 mental health patients under the Gauteng Department of Health’s care perished after being subjected to  neglect and abuse. Patients were severely malnourished and had been subjected to conditions likened to living in a concentration camp. These findings highlight the extensive work that remains to be done in regards to mental health care in South Africa.

Although national statistics estimate that  30.3% of South African adults suffer from a mental illness during their lifetimes, mental health remains a taboo subject in the nation. Cape Mental Health attributes this stigma to traditional beliefs and a lack of knowledge on what mental health care entails. 

In 2002, South Africa enacted the Mental Health Care Act  which was meant to:

  • Prohibit the unfair discrimination of those suffering from mental health disorders.
  • Ensure the dignity and privacy of patients during treatment.
  • Support mental health care services that promote the well-being of its users.

Although supported by many stakeholders, the Act has largely failed to achieve its goals due to the stigmatization of mental patients by health professionals, improper training, and a lack of resources in mental health care facilities.

As such, it is imperative that the South African government increases the funding and stresses the implementation of the Mental Health Care Act of 2002. The government should increase the funding of mental health care facilities so that they are able to expand their resources. Workshops and training programs on mental health care should be made mandatory for health care personnel, and programs that educate patients on coping strategies should also be enacted.

South Africa’s problem isn’t a faulty policy initiative, it is faulty implementation. By expanding on the resources available to mental health centers, the nation will be able to ensure that the events of February 2017 are never repeated.

A proposed modification to Brazil’s Public Expenditure Ceiling 55 (PEC 55)

March 11, 2017


Anti-government demonstrators clash with riot-policemen during a protest against the constitutional amendment PEC 55, which limits public spending, in front of Brazil's National Congress in Brasilia

Photo credit: Anti-government demonstrators clash with riot-policemen during a protest against the constitutional amendment PEC 55, which limits public spending, in front of Brazil’s National Congress in Brasilia, Brazil. REUTERS/Adriano Machado

In December 2016, the Brazilian Senate approved a cap for federal spending for the next 20 years through a constitutional amendment. Controversial President Michel Temer proposed austerity measures, known as PEC 55 (Public Expenditure Ceiling 55) to lift Brazil out of its worst economic recession ever documented. These measures include cuts to healthcare spending.

Created out of social and political unrest, the 1988 Brazilian Constitution declared health as a human right, an idea borrowed from the Declaration of Alma Ata. The Constitution authorized free public healthcare for all citizens through the Unified Health System. This system provides decentralized, comprehensive, universal health care and community-based primary healthcare services for Brazilians. About 80% of Brazilians solely use the public system for their healthcare needs.

Brazil’s Institute of Applied Economic Research estimated that the accumulated, 20-year loss to the public healthcare system due to these cuts could be a total of 654 billion Brazilian reais. The cuts will most hurt the poorest and most vulnerable populations. The cuts are expected to decrease preventative and health promotion services and also increase inequities in access to health care. The opposing majority, protesters, health experts and economic experts are raising their concerns because cuts to health and education under PEC 55 will disproportionately harm vulnerable populations such as racial minorities, the poor and the elderly. And, opponents decry PEC 55 because it will cause detrimental setbacks in education and health.

Health is not a sector in which governments should cut corners. The long-term costs and predicted increase in demand for healthcare services should outweigh the estimated budget savings. The Brazilian Senate should create an exemption in PEC 55 to allow for flexibility in healthcare spending. The spending cap should not apply to healthcare.

In this case, saving dollars just doesn’t make sense.

Emergency Funding for Zika Virus Response

August 19, 2016


On February 22nd, the Presidential office requested $1.9billion in emergency funding to support activities related to Zika virus, but these efforts have dangerously stalled in Congress. To date, nearly $600 million has been redirected by the Obama administration to fund Zika related research, front line response efforts, and vaccine development. More than half of this money was redirected from within the U.S. Department of Health and Human Services (DHHS).


Source: Healthcareit

On August 3rd, Sylvia Burwell, DHHS Secretary, informed Congress that due to the delay in approving the emergency funding, the DHHS had been forced to further reallocate up to $81 million from other programs, including the National Institutes of Health. This was extremely important because it could impact the progression of the vaccine studies currently underway, as Secretary Burwell suggested in her letter to Congress. Her letter also outlined the response by the CDC and predicted that they too would be out of Zika funding by the end of the fiscal year (Sept 2016).


Funding approval for Zika virus related activities from the U.S. is more urgent than ever. As of August 17th, the U.S. has confirmed 14 cases of locally acquired Zika virus disease – all from Florida. This was after the U.S. Centers for Disease Control (CDC) announced on August 2nd that an additional $16 million was awarded to 40 states and territories to support Zika related public health activities.

So what can you do? It is time we let our political leaders know that their constituency will not wait any longer. Follow Secretary Burwell’s lead – petition your local congressional representatives (House, Senate) and let them know this is an issue you care about. Or submit pre-formatted online petitions at Project Hope and AmeriCares. And spread the word and call to action amongst your peers.


Source: Project Hope


Women’s Health in Texas: A Need for Comprehensive Care

August 19, 2016

Funding for women’s reproductive health has been drastically reduced in the state of Texas. In 2013, the state eliminated Planned Parenthood as an option for state Medicaid beneficiaries as part of their fee-for-service family planning program. Planned Parent is the largest non-profit organization in the United States that provides reproductive health care and delivers sex education to men and women worldwide. In 2004, Planned Parenthood Federation of America has reported that 4.5 million men, women as well as teenagers have benefited from their sexual and reproductive healthcare as well as education. Without access to the services that Planned Parenthood provides, the need remains high and many women are limited in the health care they have access to and may go without routine, preventive services.


Source: Guttmacher Institute

The impact of doing so in a state with such great need should not be overlooked. As depicted above, the unintended and teen pregnancy rates; rates of Chlamydia, Gonorrhea, and new HIV diagnoses; and percent of uninsured women in need of publicly funded contraception are all higher in Texas than the national average. Women in Texas need to access care, and funding must be restored to Planned Parenthood.

Claims that the organization was misusing fetal tissue initiated the argument for and success of defunding, but these have since been proven false. Furthermore, since abortions are not legally funded by taxpayers, defunding Planned Parenthood only prevents people from accessing important health services, such as STD testing, annual reproductive exams, and prenatal care. Too many women go without these services, and the societal impacts are not slight.

This begs the question of why funding has not be restored and what must be done to see that it is. Women in Texas, and those who love, work with, or know a woman must encourage the legislature to restore funding, and in partnership with strong advocacy organizations. The Center for American Progress and National Abortion and Reproductive Rights Action League should all amplify their voice in support of the Planned Parenthood.



Source: ThinkProgress




Increasing Resource for the Mental Health of Prisoners in Ethiopia

August 16, 2016


  Mental, neurological, and substance use disorders are ubiquitous worldwide, affecting every community and age group across all income countries. About 14% of the global burden of disease is attributed to these disorders and most (75%) of the people affected in low income countries have no access to treatment Furthermore, prisons are a particular area where treatment is scarce despite the dense prevalence of mental health issues among detainees. According to the WHO, at least half of detainees have a personality disorder and one of nine detainees has a serious mental disorder (i.e. psychosis, depression).

     In 2006, with the collaboration of the WHO-AIMS, a program created to collect mental health system information specific to each country, Ethiopia published a report highlighting the lack of mental health care in the country.  The country was found to have 53 outpatient facilities, 6 inpatient facilities and one mental health hospital. None of these facilities catered to special populations, including prisoners.

    In 2012, the ministry of health and Ethiopia worked with WHO to incorporate the mental health Gap Action Programme into their country cooperation strategy. Since then they have made considerable efforts and some  headway into scaling up mental health treatment.

    While there is a general awareness of the need to improve mental health treatment in Ethiopia, there is still a limited focus on prisoners. There is no accurate count of persons with mental disorder who are incarcerated in Ethiopia. In order to necessary information about this vulnerable population, the University of Gondar did a study that found the prevalence of psychological distress among prisoners was found to be 83.4 % (95 % CI 80.6, 86.0 %).  

     Because of the challenging environment, though stakeholders are aware of the issue, their resources are not adequately allocated to this vulnerable population. The National Mental Health Strategy mentions that mental health in prisons is an important issue but fails to establish a specific plan to improve the care in prisons.

     Very little progress has been made and was last noted in 2014 when a seminar trained 17 health professionals about mental health in prisons.

     As a physician who works in LMICs, there is a notable impact of mental health on a population and in turn the economy. Mental health needs to be addressed appropriately and resources need to be designated where subpopulations are more vulnerable. There should be a stronger emphasis and resources should be directed towards detainees in mental illness in the National Mental Health Strategy with specifics numbers for funding and dedicated health care professionals.




Primary Care Physician Shortage: A dire public health crisis

March 4, 2016

physician shortage

Healthcare professional shortage is a global concern with detrimental consequences. According to the World Health Organization, there are 15% more healthcare professionals needed worldwide. In the United States, there will be an expected physician shortage of 130,600 by the year 2025. This is especially detrimental in certain specialties and rural areas is a significant concern and impediment to public health. However, certain regulations effectively limit the number of training sites, leaving increasing number of graduates “unmatched” with a residency spot. Residency is the paid training that medical graduates must go through in order to get licensed.



Regulations in the United States create an effective freeze on these spots. Medicare provides an important source of funding that helps offset some of the costs associated with educating residents, caring for patients who require more intense and complex care, and the other special missions of teaching hospitals. The Balanced Budget Act of 1997 (BBA) limited the medical residency spots that would be counted for purposes of calculating Medicare indirect medical education (IME) and direct graduate medical education (GME) reimbursement to the unweighted number on each hospital’s most recent cost report as of December 31, 1996 (BBA Section 4621). The Institute of Medicine release documents questioning the veracity of the physician shortage claims.

help wanted

More recently, the Resident Physician Shortage Reduction Act of 2015 that was introduced in the House sought to create 15,000 new resident positions (about a 15 percent increase in residency slots). By 2025, the projected need of 52,000 additional primary care physicians can only be addressed by increased funding. Remember, this reduction act will go through only if you voice support in the respective Congressional committees.

Drug-resistant malaria in Myanmar: A call for increased funding to prevent a global catastrophe

August 14, 2015

The CDC estimates there are 198 million cases of malaria that occur worldwide with more than 500,000 people dying from the disease every year. Although this disease has slowly declined in recent years, experts believe that certain endemic areas could still be at high risk for drug resistance. One such area includes Myanmar, a Southeast Asian region located on the border between India and China.

Myanmar is a high-risk area for malaria

Myanmar is a high-risk area for artemisinin resistant malaria

Over 76% of Myanmar’s population lives in regions stricken with poverty and poor health infrastructure that contribute to the mass spread of disease in areas where malaria is endemic. This area in particular is becoming resistant to artemisinin, the first line of defense. Experts suggest Myanmar is a priority region for the elimination of artemisinin resistant malaria (ARM) in order to avoid the international disaster that would result if ARM were to spread to India and Africa. Immediate and large-scale action along with substantial financial support from multiple stakeholders is needed to prevent further spread of ARM and avoid a looming malaria catastrophe. The Burmese government estimates that it will need US$1.2 billion over the next 15 years or $80 million per annum. The proposed solution would strengthen surveillance, increase rapid diagnostic testing and create new drugs to combat ARM. However, recently the Australian government, one of the 3MDG Fund donors, the largest development fund in Myanmar, has decided to cancel its pledged sum of $42 million in aid to the country. The implications of this withdrawal are uncertain and untimely.

With the ability of the malaria parasite to thwart off once effective drugs, the fear of widespread resistance is now a reality. Scientists believe we have a small window of opportunity to support Myanmar’s national campaign to increase funding to prevent a global health disaster and achieve Myanmar’s 2030 malaria elimination goals.