The Global Financing Facility (GFF) supports national reproductive, maternal, newborn, child, adolescent health, and nutrition needs. Previous analysis examined how adolescent sexual and reproductive health was represented in GFF national planning documents for 11 GFF partner countries.
This paper furthers that analysis for 16 GFF partner countries as part of a Special Series.
Content analysis was conducted on publicly available GFF planning documents for Afghanistan, Burkina Faso, Cambodia, CAR, Côte d\'Ivoire, Guinea, Haiti, Indonesia, Madagascar, Malawi, Mali, Rwanda, Senegal, Sierra Leone, Tajikistan, Vietnam. Analysis considered adolescent health content (mindset), indicators (measure) and funding (money) relative to adolescent sexual and reproductive health needs, using a tracer indicator.
Countries with higher rates of adolescent pregnancy had more content relating to adolescent reproductive health, with exceptions in fragile contexts. Investment cases had more adolescent content than project appraisal documents. Content gradually weakened from mindset to measures to money. Related conditions, such as fistula, abortion, and mental health, were insufficiently addressed. Documents from Burkina Faso and Malawi demonstrated it is possible to include adolescent programming even within a context of shifting or selective priorities.
Tracing prioritisation and translation of commitments into plans provides a foundation for discussing global funding for adolescents. We highlight positive aspects of programming and areas for strengthening and suggest broadening the perspective of adolescent health beyond the reproductive health to encompass issues, such as mental health. This paper forms part of a growing body of accountability literature, supporting advocacy work for adolescent programming and funding.
Main findings: Adolescent health content is inconsistently included in the Global Financing Facility country documents, and despite strong or positive examples, the content is stronger in investment cases than project appraisal documents, and diminishes when comparing content, indicators and financing.Added knowledge: Although adolescent health content is generally strongest in countries with the highest proportion of births before age 18, there are exceptions in fragile contexts and gaps in addressing important issues related to adolescent health.Global health impact for policy and action: Adolescent health programming supported by the Global Financing Facility should build on examples of strong country plans, be more consistent in addressing adolescent health, and be accompanied by public transparency to facilitate accountability work such as this.

The liberal international economic order has been facing high-profile legitimacy challenges in recent years. This article puts these challenges in historical context through a systematic analysis of rhetorical challenges towards both the order per se and specific global economic institutions. Drawing on Albert Hirschman\'s classic typology of exit, voice and loyalty, we coded leaders\' speeches in the General Debate at the UN General Assembly between 1970 and 2018 as articulating intentions to abandon elements of the order, challenges or calls for reform, unequivocal support, or factual mentions of cooperation. Surprisingly, we find that explicit criticisms towards the liberal order are at an all-time low and that exit threats remain rare. An analysis of the historical evolution of criticisms to global economic institutions reveals a move away from the Cold War insider-outsider conflict towards insider contestation. For example, we find that as countries\' economies become more open, their leaders expressed more support for global economic institutions during the Cold War but less support since. Finally, we demonstrate consistency between the public policy positions leaders announce in UNGA General Debate speeches and their government positions on consequential reform debates on debt relief.

UNASSIGNED: To determine the global diversity in geographical and economic class of countries contributed to group of American cardiology meetings in 2019 and 2020 (prior to and during COVID-19 pandemic).
UNASSIGNED: Cross sectional recording of contributing authors\' countries for abstracts of three American College of Cardiology Congress (ACC), Heart Failure Society of America meeting (HFSA) and Transcatheter Cardiovascular Therapeutics (TCT) meeting. Analysis of these contributions according to continent and World Bank Class of the contributing countries was done.
UNASSIGNED: total 10,609 contributions from 95 countries were analysed. After excluding US, Asia had the highest contribution to ACC meetings in 2019 (45.44%) and 2020 (42.63%), p = 0.0002, while Europe had the highest contributions to both HFSA (58.78% in 2019 and 47.42% in 2020), p = 0.07 and TCT (63.25% in 2019 and 55.86% in 2020), p = 0.0002. Middle income countries (MIC) contributions increased from 14.96%, 10.02%, 6.06% in 2019 (pre COVID19) to 19.29%, 19.34%, 17.52% in 2020 (COVID19 era) in ACC, HFSA and TCT respectively.
UNASSIGNED: Researchers from low- and middle-income countries are under-represented in high impact American cardiology meetings with higher contributions in COVID-19 era. It is pivotal to enhance collaboration with them to reflect the real solidarity for which we are calling during and beyond the pandemic.

UNASSIGNED: The Global Health Governance (GHG) response to the COVID-19 pandemic has been criticized, particularly regarding vaccine management, and changes in the roles of GHG actors have been recommended.
UNASSIGNED: To investigate the perception of experts regarding changes in the roles of different GHG actors following the COVID-19 pandemic.
UNASSIGNED: This study used a 3-round Delphi survey to collect data from 30 global health experts between May and December 2022. The GHG roles investigated were stewardship, production of guidelines and policies, promotion of solidarity and collaboration, and management of global health challenges. Social network analysis was performed and collected data was converted into a 1-mode network. Degree centrality and Eigenvector centrality were calculated using the UCINET 6.757 modelling programme.
UNASSIGNED: There were variations between the current and future roles in degree centrality and eigenvector centrality for the 19 GHG actors in each of the 4 functions investigated. For stewardship, WHO, governments and the World Bank had the highest degree centrality and eigenvector centrality during both the current and future periods. In terms of production of guidelines and policies, WHO maintained the highest current and future eigenvector centralities, while research agencies, UNICEF and Gavi upheld their current eigenvector centrality measure. For the promotion of solidarity and collaboration, WHO had the highest centrality measures, followed by UNICEF, governments and Gavi. Regarding the function \"management of global health challenges\", WHO lost its position to UNICEF as the most central, while UNDP, FHI 360 and research agencies were predicted to have a more central role in the future.
UNASSIGNED: The findings position WHO as the current and future top actor in stewardship, production of guidelines and policies, and promoting solidarity and collaboration, and UNICEF as the upcoming most central actor in managing global health challenges. Governments were major actors in all GHG functions except for managing global health challenges. Funding actors were central in all GHG functions, indicating finance as an important factor in obtaining a central role in GHG. Research organizations received a high centrality rating, indicating their importance in GHG.
الأدوار المتغيرة في حوكمة الصحة العالمية عقب جائحة كوفيد-19.
صنجسو شن، وفاء أبو الخير مطرية، حسن الفوال.
UNASSIGNED: تعرَّضت استجابة حوكمة الصحة العالمية لجائحة كوفيد-19 لانتقادات عدة، لا سيَّما فيما يتعلق بإدارة اللقاحات.
UNASSIGNED: هدفت هذه الدراسة الى اجراء استقصاءً لتصوُّر الخبراء عن أدوار الجهات الفاعلة المختلفة في مجال حوكمة الصحة العالمية أثناء جائحة كوفيد-19 وبعدها.
UNASSIGNED: استخدمت هذه الدراسة مسح دلفي من 3 جولات لجمع بيانات من 30 خبيرًا عالميًّا في مجال الصحة في المدة بين مايو/ أيار وديسمبر/ كانون الأول 2022. وشملت الأدوار الخاضعة للاستقصاء: الإشراف، وإعداد المبادئ التوجيهية والسياسات، وتعزيز التضامن والتعاون، وإدارة التحديات الصحية العالمية. وحسبنا درجة المركزية ومركزية المتجه الذاتي باستخدام تحليل الشبكة الاجتماعية. وحُولِّت البيانات التي جرى الحصول عليها إلى شبكة من النمط 1، ثم حُسبت مقاييس المركزية السابقة ببرنامج النمذجة 6,757 UCINET.
UNASSIGNED: كانت هناك تفاوتات في درجة المركزية ومركزية المتجه الذاتي بالنسبة للجهات الفاعلة البالغ عددها 19 في مجال حوكمة الصحة العالمية في كل وظيفة من الوظائف الأربع التي استُقصيت. فبالنسبة للإشراف، حصلت منظمة الصحة العالمية والحكومات والبنك الدولي على درجات ومركزيات متجه ذاتي أعلى خلال المدتين الحالية والمقبلة. وبالنسبة لإعداد المبادئ التوجيهية والسياسات، حافظت منظمة الصحة العالمية على أعلى مركزيات المتجه الذاتي، في حين استوفت وكالات البحوث واليونيسف والتحالف العالمي من أجل اللقاحات والتمنيع مقياس مركزية المتجه الذاتي الخاص بها. وبالنسبة لتعزيز التضامن والتعاون، حققت منظمة الصحة العالمية أعلى مقاييس المركزية، تلتها اليونيسف والحكومات والتحالف العالمي من أجل اللقاحات والتمنيع. وفيما يتعلق بوظيفة المركزية لإدارة التحديات الصحية العالمية، فقدت منظمة الصحة العالمية مكانتها الأولى لصالح اليونيسف التي حازت تصنيف الأكثر مركزية. واحتفظت منظمة الصحة العالمية واليونيسف فقط بمكانيهما بين أكثر 5 جهات فاعلة مركزية.
UNASSIGNED: تضع النتائج منظمة الصحة العالمية على رأس الجهات الفاعلة في الإشراف وإعداد المبادئ التوجيهية والسياسات وتعزيز التضامن والتعاون، ووضعت النتائج أيضًا اليونيسف على رأس الجهات الفاعلة المستقبلية الأكثر مركزية في إدارة التحديات الصحية العالمية. وكانت الجهات الفاعلة في مجال التمويل مركزية في جميع وظائف حوكمة الصحة العالمية، وهو ما يشير إلى أن التمويل عامل مهم في الحصول على دور مركزي في مجال حوكمة الصحة العالمية. وقد حصلت المنظمات البحثية على تصنيف مرتفع للمركزية، الأمر الذي يشير إلى أهميتها في مجال حوكمة الصحة العالمية.
Évolution des rôles dans la gouvernance sanitaire mondiale après la pandémie de COVID-19.
UNASSIGNED: La réponse apportée dans le cadre de la gouvernance sanitaire mondiale face à la pandémie de COVID-19 a été critiquée, notamment en ce qui concerne la gestion des vaccins, et des changements des rôles des acteurs impliqués dans ce processus ont été recommandés.
UNASSIGNED: Examiner la perception des experts concernant les changements des rôles des différents acteurs de la gouvernance sanitaire mondiale suite à la pandémie de COVID-19.
UNASSIGNED: La présente étude a utilisé une enquête en trois tours selon la méthode Delphi en vue de recueillir des données auprès de 30 experts de la santé mondiale entre mai et décembre 2022. Les rôles de la gouvernance sanitaire mondiale examinés étaient la gestion stratégique, la formulation de lignes directrices et de politiques, la promotion de la solidarité et de la collaboration, et la gestion des défis mondiaux en matière de santé. Une analyse des réseaux sociaux a été réalisée et les données obtenues ont été converties en un réseau mode 1. Le degré de centralité et la centralité de vecteur propre ont été calculés à l\'aide du programme de modélisation UCINET 6.757.
UNASSIGNED: Des variations ont été observées entre les rôles actuels et futurs en termes de degré de centralité et de centralité de vecteur propre pour les 19 acteurs de la gouvernance sanitaire mondiale dans chacune des quatre fonctions étudiées. Pour la gestion stratégique, l\'OMS, les gouvernements et la Banque mondiale présentaient les degrés de centralité et les centralités de vecteur propre les plus élevés, tant pour la période actuelle que pour la période future. En ce qui concerne la formulation de lignes directrices et de politiques, l\'OMS a maintenu la centralité de vecteur propre la plus élevée pour les périodes actuelle et future, tandis que les organismes de recherche, l\'UNICEF et Gavi ont conservé leur mesure actuelle de centralité de vecteur propre. Pour ce qui est de la promotion de la solidarité et de la collaboration, l\'OMS a obtenu les mesures de centralité les plus élevées, suivie de l\'UNICEF, des gouvernements et de Gavi. Enfin, eu égard à la fonction « gestion des défis mondiaux en matière de santé », l\'OMS a cédé sa position au profit de l\'UNICEF qui a obtenu les mesures de centralité les plus élevées, tandis que le PNUD, FHI 360 et les organismes de recherche devraient jouer un rôle davantage central à l\'avenir.
UNASSIGNED: Les résultats de l\'étude montrent que l\'OMS est l\'acteur principal actuel et futur pour ce qui est de la gestion stratégique, de la formulation de lignes directrices et de politiques, et pour la promotion de la solidarité et de la collaboration, et que l\'UNICEF est l\'organisme qui jouera un rôle central dans la période à venir pour ce qui est de la gestion des défis mondiaux en matière de santé. Les gouvernements ont été des acteurs majeurs dans toutes les fonctions de gouvernance sanitaire mondiale, à l\'exception de la gestion des défis mondiaux en matière de santé. Les acteurs du financement ont joué un rôle central dans toutes les fonctions liées à la gouvernance sanitaire mondiale, ce qui indique que le financement constitue un facteur important pour l\'obtention d\'un tel rôle dans ce domaine. Les organismes de recherche ont reçu une note de centralité élevée, ce qui témoigne de leur importance dans la gouvernance sanitaire mondiale.

Rising incomes across low-and middle-income countries (LMIC) lead to a lower consumption of starchy staples and create a growing demand for high-quality animal protein, an observation referred to as Bennett\'s law. This dietary shift from plant-sourced to animal-sourced proteins has also been referred to as the LMIC protein transition. At this time, there are rising concerns that current livestock production is highly resource intensive and may not meet the growing global demand for high-quality protein. Alternative plant-based proteins, derived from new technologies and often fortified with micronutrients, are intended to close the LMIC nutrient gap. However, data from LMIC suggest that the income-driven selection of animal proteins is aspirational and varies by stage of economic development. Food balance sheets from higher-income countries indicate that meat consumption peaks only at very high incomes. Will plant-based alternative proteins satisfy the growing LMIC demand for animal-sourced foods, thereby negating Bennett\'s law? Current evidence suggests otherwise.

Decompensated cirrhosis and hepatocellular cancer are major risk factors for mortality worldwide. Liver transplantation (LT), both live-donor LT or deceased-donor LT, are lifesaving, but there are several barriers toward equitable access. These barriers are exacerbated in the setting of critical illness or acute-on-chronic liver failure. Rates of LT vary widely worldwide but are lowest in lower-income countries owing to lack of resources, infrastructure, late disease presentation, and limited donor awareness. A recent experience by the Chronic Liver Disease Evolution and Registry for Events and Decompensation consortium defined these barriers toward LT as critical in determining overall survival in hospitalized cirrhosis patients. A major focus should be on appropriate, affordable, and early cirrhosis and hepatocellular cancer care to prevent the need for LT. Live-donor LT is predominant across Asian countries, whereas deceased-donor LT is more common in Western countries; both approaches have unique challenges that add to the access disparities. There are many challenges toward equitable access but uniform definitions of acute-on-chronic liver failure, improving transplant expertise, enhancing availability of resources and encouraging knowledge between centers, and preventing disease progression are critical to reduce LT disparities.

This study views sustainability after the exit of development assistance for health (DAH) as a shared responsibility between donors and recipients and sees transitioning DAH-supported interventions into domestic health policy as a pathway to this sustainability. It aims to uncover and understand the reemergent aspects of the donor-recipient dynamic in DAH and how they contribute to formulating domestic health policy and post-DAH sustainability.
We conducted a case study on two DAH-supported interventions: medical financial assistance in the Basic Health Services Project supported by the World Bank and UK (1998-2007) and civil society engagement in the HIV/AIDS Rolling Continuation Channel supported by the Global Fund (2010-2013) in China. From December 2021 to December 2022, we analyzed 129 documents and interviewed 46 key informants. Our data collection and coding were guided by a conceptual framework based on Walt and Gilson\'s health policy analysis model and the World Health Organization\'s health system building blocks. We used process tracing for analysis.
According to the collected data, our case study identified three reemergent, interrelated aspects of donor-recipient dynamics: different preferences and compromise, partnership dialogues, and responsiveness to the changing context. In the case of medical financial assistance, the dynamic was characterized by long-term commitment to addressing local needs, on-site mutual learning and understanding, and local expertise cultivation and knowledge generation, enabling proactive responses to the changing context. In contrast, the dynamic in the case of HIV/AIDS civil society engagement marginalized genuine civil society engagement, lacked sufficient dialogue, and exhibited a passive response to the context. These differences led to varying outcomes in transnational policy diffusion and sustainability of DAH-supported interventions between the cases.
Given the similarities in potential alternative factors observed in the two cases, we emphasize the significance of the donor-recipient dynamic in transnational policy diffusion through DAH. The study implies that achieving post-DAH sustainability requires a balance between donor priorities and recipient ownership to address local needs, partnership dialogues for mutual understanding and learning, and collaborative international-domestic expert partnerships to identify and respond to contextual enablers and barriers.

暂无摘要。

This article investigates how international decision-making\'s conditionality aids countries during strenuous economic conditions imposed by the COVID-19 pandemic. It examines and contrasts the European Union\'s conditionality policies, the International Monetary Fund, and the World Bank as the more influential and leading groups of institutions. The article reveals notable policy differences. As opposed to that of the IMF and WB, the EU\'s approach is more comprehensive and not confined to economic considerations. Those variations aside, the article draws on the same premise: expectations of compliance with the set conditions. While in-depth, structural requirements could guide ordinary decision-making and build up resilient national institutions and policies, this article questions the merits of large-scale comprehensive terms in the face of a situation created by a force majeure or a humanly uncontrollable event such as the COVID-19 pandemic. With no more initial research addressing the specific question of the application and adequacy of conditionality to force majeure emergencies or pandemic situations of the scale of COVID-19, this article argues in favor of a measured and targeted response limited to the development, design, or determination of policy choices that tackle the intended purpose. Also, for validly practical considerations that search for to ensure the better use of aid and avoid distracting or overburdening the recipient countries to the point of risking losses of devastating proportions, the article proposes to revise and limit conditionality during force majeure events to the essential aspects of transparent management of funds for the sole intended purpose. This in itself is a distinct democratic exercise of efficient and accountable public management decision-making.

It is helpful to divide the global HIV response into three phases: The first, from about 1980 to 2000, represents \"Calamity\". The second, from roughly 2000 to 2015 represents \"Hope.\" The third, from 2015, is unfolding and may be termed \"Choices\" - and these choices may be severely constrained by COVID, so \"Constrained Choices in an era of COVID\" may prove more apt. As we take stock of HIV at 40, there are positive lessons for the wider health response - and challenging reflections for the wider impact of the global HIV response. The positive lessons include: (1) the importance of activism; (2) the role of scientific progress and innovation; (3) the impact of evidence in concentrating resources on proven approaches; (4) the importance of surveillance to understanding transmission dynamics; (5) the use of epidemic intelligence to guide precision implementation; (6) the focus on implementation cascades (diagnosis, linkage, adherence, disease suppression); and finally (7) an overarching execution and results focus.Given this remarkable legacy, it seems churlish to ask whether the HIV response could have achieved more. Yet, consider these approximate figures. Development assistance for HIV totals about 100 billion dollars, 70 billion from the USA matched by roughly 100 billion in domestic resources. For 200 billion dollars, should we not have achieved more than 23 million people initiating treatment (very crudely, 10 000 dollars per person on treatment)? Much of the hundred billion dollars of development assistance (roughly half) focused on about a dozen priority countries in eastern and southern African. The larger PEPFAR recipients, with populations of roughly 50 million, each received 5 billion dollars or more cumulatively. And there are further Global Fund contributions of an additional billion dollars in many of these countries. For 6 billion dollars per country, should we have expected more?The World Bank Human Capital Project posits that to maximize human capital formation, countries must ensure that their children survive, are well nourished and stimulated, learn skills and live long, productive lives. Using the Human Capital Index (a composite index based on these factors), South Africa - the largest HIV financing recipient - ranks 126th of 157 countries, below Haiti, Ghana, the Congo Republic, Senegal and Benin. Consider how many recipients of major HIV development finance fall into the bottom fifth: Namibia, Botswana, Eswatini (formerly Swaziland), Malawi, South Africa, Tanzania, Zambia, Uganda, Lesotho, Ethiopia, Mozambique, Cote D\'Ivoire and Nigeria. Of course, causality is unresolved and there are several possible explanations: (1) low human capital formation may increase HIV transmission; (2) the HIV epidemic may have intergenerational impacts; (3) the all-consuming focus on HIV may have displaced other health, education and development priorities. Yet, it remains hard to see these data and to argue that successful HIV responses among the largest HIV financing recipients strengthened their wider health sector and human development outcomes.A plausible principle emerges. Narrowly targeted disease-specific emergency responses may lead to disease-specific gains but do not improve governance or national systems capacity or wider disease or development outcomes. This is not to undermine the emergency origins of the HIV response; 2021 is not 2000 and it is unlikely that we would have 23 million people initiating treatment without an emergency response. Yet, there are reasons (intensified by COVID), to suggest that we must pivot towards long-term, integrated, developmental, nationally owned and financed, systems-orientated responses - particularly when both development assistance and national budgets are likely to be constrained in an era of COVID.