News Flash 665: Weekly Snapshot of Public Health Challenges

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

White seabream (Diplodus sargus sargus)

News Flash 665

Weekly Snapshot of Public Health Challenges

 

Global health reform cannot wait for a new world order. Middle powers must act now

G2H2 Annual Report 2025

Pushing back against erasure: The Gaza flotilla is more important now than ever

Aylania: a New Europe Founded on Peace and Justice   by Juan Garay 

Spain awards UN legal expert Francesca Albanese one of its highest civilian honours. Honour recognises Albanese’s work ‘documenting and denouncing violations of international law in Gaza’

Meeting registration. JVP HAC Webinar Sunday May 17: Fragile Crossings: The Pathways, Barriers, and Cost of Pediatric Medical Evacuations From Gaza

The deliberate restriction of food and aid led to alarming malnutrition levels in Gaza

Trump aid cuts help push Gaza’s struggling mothers to the brink: ‘Our suffering is immense’

Empowering Adolescent Girls: Does It Take a Village?

Launching the Charter for Feminist Health Systems

HRR817. MY 2026 INCENSED AND DISCONCERTED STATED OF MIND: CALLING A SPADE A SPADE

Webinar registration: IFIC Forum Discussion on People as Partners Jun 4, 2026

Donors Are Increasingly Focusing on “Systems Strengthening”: How Can They Do It Well?

US rejects UN migration forum declaration, State Department says

Indigenous Amazon groups urge the UN to curb organized crime, not militarize territories 

Talks on protection of traditional knowledge and traditional cultural expressions stalled

International Conference Explores How Medical Care Commercialization Has Resulted in Higher Costs, Poorer in U.S.

New WHO online course strengthens good practices in clinical trials

MPP at the 79th World Health Assembly (WHA)

DNDi’s briefing note for 79th World Health Assembly

DNDi welcomes GHIT support for global evaluation and registration of fosravuconazole for eumycetoma, in collaboration with Eisai

HIV jab demand outstrips supply in African rollout

Girls in SA get free HPV jabs. Boys don’t. Find out why they should

From Silos to Synergy: First TB–EPI Communities Partnership to Support New TB Vaccines Introduction

Vaccination Campaigns as Stress Tests of PHC Systems in Africa: Lessons from the Integrated Measles Rubella Campaign in Nigeria  by Ebenezer Bolaji 

When Community Health Workers Become the First Line of Epidemic Defense: Lessons from Measles Outbreaks in Northern Côte d’Ivoire  by Issa Barry

Nurses Are Not a Cost to Health Systems. They Are the Power Holding Them Together

Food Systems and Policies Undermining Food Security

Rare earth mining is poisoning Mekong River tributaries, threatening ‘the world’s kitchen’

Climate change and non-communicable diseases: An invisible syndemic

 

 

 

 

 

 

 

 

Aylania: a New Europe Founded on Peace and Justice

IN A NUTSHELL
Editor's note
A follow up reflection here by the Author on his previous article 'A New Horizon: From Broken Systems to Living Communities' PEAH published a few days ago

By Juan Garay

Co-Chair of the Sustainable Health Equity Movement (SHEM)

Professor/Researcher of Health Equity, Ethics and Metrics (Spain, Mexico, Cuba, Brazil)

Founder of Valyter Ecovillage (valyter.es)

By the same Author on PEAH: see HERE

Aylania: a New Europe Founded on Peace and Justice

 

Europe was a young Phoenician woman abducted by a bull. Thousands of years later, the same sea remembers: four hundred souls on the Sumud flotilla, abducted now by naval forces. Europe, born of a rape, collaborates with the kidnappers. Its courts call our rescue fleet pirates, while they remain silent as children die every day under the impunity of bombs falling in the most atrocious genocide.

That is why we carry in our memory two small bodies that the world saw and then buried. That of Mohamed al-Durra, twelve years old, pressed against the wall of an alley in Gaza as his father tried to shield him. They filmed his death live: forty-five minutes of bullets, until his white t-shirt turned red. And that of Aylan, the three-year-old Kurdish boy, drowned in the Mediterranean, his small body face down on the Turkish shore like a mirror that Europe looked at one day and then shattered so as not to see itself.

They represent thousands of girls and boys murdered by the greed of privilege, the impunity of power, and the cowardice of complicit silence.

That Europe of walls and selfishness, which signs arms deals while Gaza starves, which calls pirates those who rescue and heroes those who bomb schools, has no right to utter the word peace. That is why we dream of re-founding Aylania: not a country on the map, but an ethical territory of open arms. Aylania is where no father will ever again see his son die against a wall. Aylania is where the Mediterranean is not a children’s cemetery, but a cradle of welcome. It is the antithesis of this Europe that drowns on its coasts and murders with its bombs.

We keep sailing. The ghost of Don Quixote rides on our bow: not against windmills, but against the monstrous machinery that turns siege into policy and the death of children into a footnote statistic.

We are four hundred dreamers of justice, from every corner of the world and every condition. We know that carrying flour and medicine to Gaza makes us criminals in the eyes of the empire. So we honor ourselves in being pirates who break immoral laws. Pirates of peace, like Gandhi’s salt march: our salt is the tears of mothers under the rubble, and the tiny bodies of Mohamed and Aylan that push us never to let go.

In international waters we are attacked. Our companions are kidnapped, our boats damaged. But sumud is the art of not letting go. We stitch wounds, repair, and return. We will spread the names of European rulers who sign weapons deals while children starve. We form a human chain, a hyapry: each knot is a body preventing the next from drowning. Thus, like a chain linking the shore where Aylan appeared with the rubble where Mohamed fell, we refuse to let their deaths be in vain.

We are heading to Turkey, not to retreat but to rebuild. Because the dream is a fleet, and beneath that dream lies the oven of Gaza: a new humanity is born from its ashes. That new humanity is called Aylania. They will not kill it with bombs or decrees. We are that utopia they will not kill. We sail, we sail, we sail. Now the only pirates are those who tried to drown us — them, Aylan, Mohamed. We are the pirates of peace. And as long as there is a child under the rubble, a child in the water, a child against a wall, a child without food, we will keep being pirates. Because peace is not a palace agreement: it is a fleet of pirate dreamers full of flour and medicines, it is an open arm, it is re-founding Aylania on the ashes of this soulless Europe.

 

Vaccination Campaigns as Stress Tests of PHC Systems in Africa: Lessons from the Integrated Measles Rubella Campaign in Nigeria

IN A NUTSHELL
Author's Note 
…this article explores how vaccination campaigns expose critical system dynamics and what lessons they offer for strengthening Primary Health Care (PHC) delivery in Africa…

…The experiences from the MR campaign suggest several important lessons:

 •  Invest in sustainable workforce capacity to reduce over reliance on ad hoc staff
• Continuously update microplans and population data to reflect dynamic community realities
• Strengthen digital infrastructure and user support systems for health workers
• Integrate social and community structures into routine PHC delivery, not just campaigns
• Ensure continuity of routine services during high intensity interventions…

By Ebenezer Bolaji, MD

MSc (Clinical Research in International Health, University of Barcelona)

Head, PHC Research Unit, National Primary Health Care Development Agency, Nigeria

AVoHC Rapid Responder Epidemiologist, Africa CDC

 Vaccination Campaigns as Stress Tests of PHC Systems in Africa: Lessons from the Integrated Measles Rubella Campaign in Nigeria

 

Introduction

Vaccination campaigns are among the most visible public health interventions in low and middle income countries. A vaccination campaign can be described as a time bound, large scale public health effort designed to rapidly increase population immunity by delivering vaccines to a defined target group, often through intensified outreach strategies that go beyond routine service delivery.

In Nigeria, campaigns such as the Measles Rubella (MR) vaccination exercise are implemented through the national and subnational health systems. While their primary objective is disease control and elimination, these campaigns also serve another, less discussed function. They act as stress tests for Primary Health Care (PHC) systems.

By placing extraordinary demands on workforce capacity, logistics, data systems, and community engagement structures, campaigns reveal both the resilience and the limitations of PHC systems. Drawing from field experiences during national supervisory roles in the MR campaign and related household enumeration exercises, this article explores how vaccination campaigns expose critical system dynamics and what lessons they offer for strengthening PHC delivery in Africa.

The Role of PHC Systems in Vaccination Campaigns

Vaccination campaigns do not operate independently. They are deeply embedded within existing PHC systems. Their success depends on how effectively these systems can be mobilized.

  1. Workforce Mobilization and Service Delivery

PHC systems provide the backbone of human resources for campaigns. Health workers, community health extension workers, and local mobilizers are redeployed to support vaccination teams, supervision, and data collection.

During field supervision, one team lead remarked:
“We are used to routine immunization days, but campaigns are different. You are expected to cover everywhere.”

This surge capacity often requires temporary expansion through volunteers and ad hoc staff, highlighting both the flexibility and limitations of the existing workforce.

  1. Governance and Coordination Structures

Campaigns activate multi-level governance systems from national coordination to state, LGA (Local Government Area), and ward level implementation. These structures facilitate planning, supervision, and accountability.

An Immunization Officer noted:
“The campaign brings everyone to the table, health, statistics, community leaders. It shows what coordination can look like when there is urgency.”

This demonstrates the potential of PHC governance systems when fully mobilized, but also underscores the need for sustained coordination beyond campaign periods.

  1. Technology and Data Systems (ODK and CAPI)

Digital tools such as Open Data Kit and Computer Assisted Personal Interviewing platforms have become central to data collection during campaigns and household listing exercises.

However, field realities shape their effectiveness. As one data enumerator shared:
“We understand how to use the device, but sometimes there is no network for hours. You just have to keep moving and upload later.”

Another added:
“Power is also a challenge. If your device goes off in the field, your work stops.”

These experiences highlight that technology adoption is not just about tools, but about infrastructure readiness and user support systems.

  1. Cold Chain and Logistics Systems

PHC systems also support the cold chain infrastructure required to maintain vaccine potency. Campaigns test the ability of facilities to store, transport, and manage vaccines under increased demand.

A vaccinator explained:
“On campaign days, the volume is much higher. You have to plan carefully so that vaccines last the whole day without wastage.”

   

 

Images from the field

 

Campaigns as Stress Tests: What Do They Reveal?

  1. Human Resource Gaps and Service Disruptions

One of the most immediate effects of campaigns is the strain on available human resources. To meet campaign targets, health workers are often redeployed from routine services.

As observed in the field:
“During the campaign, most of us are outside. Routine immunization is adjusted to specific days at the facility.”

Another health worker noted:
“If we had more hands, we would not need to shift routine services.”

This reflects a broader system challenge. Balancing campaign intensity with continuity of routine PHC services.

  1. Microplanning Gaps and Last Mile Realities

Microplanning is central to campaign success, yet field implementation often reveals discrepancies between plans and reality, particularly in hard-to-reach areas.

A community health worker stated:
“There is a need to update the micro plan of our settlement. Some households are not where they used to be.”

In remote areas, distance and terrain significantly affect service delivery:
“Some households are very far apart. You can spend hours reaching just a few families.”

These insights emphasize the importance of continuously updating settlement data and understanding local geography, especially in underserved communities.

They also raise a critical question:
Outside of campaigns, how consistently do these communities receive PHC services?

  1. Technology Utilization Gaps

While digital tools improve data quality and timeliness, campaigns reveal gaps in digital literacy, infrastructure, and system integration.

A supervisor reflected:
“The tools are good, but they require support, network, power, and training. Without these, the process slows down.”

This underscores the need for context aware digital health strategies that align with on the ground realities.

  1. Social Determinants and Community Based Solutions

To address geographic and access barriers, campaigns often leverage social infrastructure such as schools, markets, and places of worship as vaccination sites.

A community mobilizer explained:
“When we set up at the market, more people come. It reduces the distance for many families.”

Similarly:
“Using churches and schools helps us reach people who may not come to the health facility.”

These approaches highlight how social determinants of health such as location, mobility, and community structures can be leveraged to improve access.

Lessons for Strengthening PHC Systems

The experiences from the MR campaign suggest several important lessons:

• Invest in sustainable workforce capacity to reduce over reliance on ad hoc staff
• Continuously update microplans and population data to reflect dynamic community realities
• Strengthen digital infrastructure and user support systems for health workers
• Integrate social and community structures into routine PHC delivery, not just campaigns
• Ensure continuity of routine services during high intensity interventions

 

Conclusion

Vaccination campaigns are more than short term public health interventions. They are windows into the functioning of PHC systems. By placing systems under pressure, they reveal operational realities that are often less visible during routine service delivery.

The lessons from Nigeria’s Measles Rubella campaign demonstrate that strengthening PHC systems requires not only technical solutions, but also a deep understanding of field realities where geography, human resources, technology, and community dynamics intersect.

If these lessons are systematically captured and integrated into policy and practice, campaigns can evolve from episodic interventions into catalysts for long term health system strengthening.

 

 

 

When Community Health Workers Become the First Line of Epidemic Defense: Lessons from Measles Outbreaks in Northern Côte d’Ivoire

IN A NUTSHELL
Author's Note 
The article draws on Northern Côte d’Ivoire field experience to highlight the critical role of Community Health Workers (CHWs), through risk communication and community engagement (RCCE), during outbreaks and in epidemic preparedness in resource-limited settings.

Three strategic priorities emerge from this experience:

Institutionalize RCCE as a core pillar of health security, embedded in routine systems rather than activated only during crises

Invest sustainably in CHWs, including training, supervision, fair remuneration, and formal recognition within national health systems

Strengthen the community-health system interface, ensuring that trust, local knowledge, and social dynamics are leveraged as strategic assets

By Issa Barry, MD, MPH

Public Health & Humanitarian Action

djambarry00@gmail.com

When Community Health Workers Become the First Line of Epidemic Defense: Lessons from Measles Outbreaks in Northern Côte d’Ivoire

 

Epidemic preparedness starts in the community

In many rural settings across West Africa, epidemic preparedness does not begin in laboratories or national contingency plans. It begins in the community.

In Northern Côte d’Ivoire, during recent measles outbreaks, Community Health Workers (CHWs) have emerged as a critical interface between the health system and the population. Through risk communication and community engagement (RCCE), they bridge the gap between formal health structures and everyday realities, playing a decisive role in early detection, rapid response, and the rebuilding of trust in vaccination.

This experience reflects a broader consensus in global health that effective preparedness relies not only on technical capacity but also on strong community-based systems, as emphasized in global guidance such as the World Health Organization RCCE framework (https://www.who.int/publications/i/item/risk-communication-and-community-engagement-(rcce)-action-plan-guidance).

Delayed detection and fragile trust

Measles remains a highly contagious disease and a persistent public health threat in many low-resource settings, despite the availability of a safe and effective vaccine. According to the World Health Organization, outbreaks continue to occur primarily in areas with gaps in immunization coverage and weak surveillance systems (https://www.who.int/news-room/fact-sheets/detail/measles).

In rural contexts, structural and social barriers undermine timely outbreak response. Detection of suspected cases is often delayed due to geographic constraints and limited access to health facilities. At the same time, misinformation, rumors, and vaccine hesitancy continue to affect vaccination uptake.

Crucially, communities are too often positioned as passive recipients of interventions rather than active partners in surveillance and response. This disconnect weakens preparedness systems and allows outbreaks to spread before formal mechanisms are fully activated.

A community-anchored response

Within a community-based health program implemented in Northern Côte d’Ivoire, CHWs operate at the frontline of epidemic preparedness through an RCCE-centered approach. Working in close collaboration with primary health care facilities, they maintain continuous links with frontline health services, to which they refer suspected cases, thereby acting as a critical interface within the health system.

Their proximity to households enables a shift from passive to proactive surveillance. CHWs identify suspected measles cases directly within communities, on average within 24 hours of symptom onset, significantly reducing delays in detection and reporting.

They conduct regular home visits, combining surveillance with interpersonal communication. These interactions go beyond information delivery; they create space for dialogue, trust-building, and behavioral change.

Through these engagements, CHWs promote early recognition of symptoms, encourage timely care-seeking, address fears and misconceptions related to vaccination, and adapt public health messages to local socio-cultural contexts.

Embedded within their communities, CHWs also play a critical role in identifying and countering rumors. In practice, this has translated into more frequent identification of suspected cases at the household level and improved follow-up of children who had missed routine immunization.

Bridging data and action

An important dimension of this approach lies in the integration of digital tools into community-based work (community health toolkit-CHT). Equipped with tablets and continuously updated household registries, CHWs identify children who have missed vaccination doses and ensure targeted follow-up.

This approach aligns with broader global efforts to leverage digital health for strengthening health systems (https://www.who.int/health-topics/digital-health). By linking real-time data with community presence, surveillance, communication, and vaccination efforts become more coordinated and responsive.

From reaction to anticipation

This CHW-led, RCCE-driven model contributes to a shift in how epidemic preparedness is operationalized.

Earlier detection and reporting of suspected cases reduce delays in response and limit potential transmission chains. Vaccination uptake improves as trust is progressively rebuilt through sustained engagement. Adherence to public health recommendations increases, supported by continuous, culturally grounded communication.

Beyond these measurable outcomes, a more profound transformation takes place: communities become active participants in health security rather than passive beneficiaries.

In this sense, preparedness evolves from a reactive model, triggered once outbreaks escalate, towards a more anticipatory and community-informed approach.

Persistent challenges and structural limitations

Despite these advances, important challenges remain and must be addressed to sustain and scale such approaches.

Limited internet connectivity continues to constrain real-time reporting in remote areas. CHWs face increasing workloads as their responsibilities expand, often without commensurate support. Gaps in digital literacy can limit the effective use of technological tools.

More fundamentally, the often-informal status of CHWs raises concerns about sustainability, motivation, and long-term system integration. As highlighted in the World Health Organization guideline on optimizing community health worker programmes (https://www.who.int/publications/i/item/9789241550369), sustained investment in CHWs remains a critical gap in many health systems.

These constraints reflect a broader global challenge: while CHWs are increasingly recognized as essential to primary health care and even epidemic preparedness, investment in their support systems remains insufficient.

Rethinking epidemic preparedness

This experience calls for a re-examination of how epidemic preparedness is conceptualized in resource-limited settings.

Too often, preparedness is framed primarily in terms of technical capacities (laboratories, surveillance infrastructures, and emergency response teams) while underestimating the foundational role of community-based systems.

CHWs should not be regarded as auxiliary actors but as integral components of epidemic intelligence, risk communication, and response effectiveness.

Three strategic priorities emerge:

  • Institutionalize RCCE as a core pillar of health security, embedded in routine systems rather than activated only during crises
  • Invest sustainably in CHWs, including training, supervision, fair remuneration, and formal recognition within national health systems
  • Strengthen the community-health system interface, ensuring that trust, local knowledge, and social dynamics are leveraged as strategic assets

Such shifts are essential not only for improving outbreak response but also for advancing equitable access to health, in line with global commitments to universal health coverage.

Investing where it matters most

The lessons from measles outbreak response in Northern Côte d’Ivoire are clear: effective epidemic preparedness depends not only on technical capacity, but on trust, proximity, and sustained community engagement.

CHWs stand at the heart of this equation. Investing in their capacity, recognition, and integration is not a peripheral choice; it is a strategic imperative for strengthening health systems and advancing global health security.

In the face of future epidemics, the question is no longer whether communities should be involved, but how far health systems are willing to go to place them at the center of preparedness and response.

 

Disclaimer

The views expressed in this article are those of the author and do not necessarily reflect the official position of any affiliated organization

News Flash 664: Weekly Snapshot of Public Health Challenges

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

Striped seabream (Lithognathus mormyrus)

News Flash 664

Weekly Snapshot of Public Health Challenges

 

‘Health In All Policies’ Is An Effective Governance Framework. Why Have Our Leaders Ignored It?

Implementing Learning Health Systems in Africa: Strategies, Outcomes, and Real-World Applications for Equitable Access  by Kirubel Workiye Gebretsadik 

Moving from commitments to contextualized action: Some reflections from the World Health Summit regional meeting in Nairobi 

A New Horizon: From Broken Systems to Living Communities  by Juan Garay

A life course approach to health and well-being: call for papers

An uncomfortable truth: healthcare is both a protector of health and a contributor to one of its greatest threats

Concord: Letter to all Development and Foreign Affairs Ministers of EU Member States

UNLOCKING NEW PATHWAYS FOR ERADICATING POVERTY BEYOND GROWTH

Webinar registration: International migration of health workers and the crisis of care: what is to be done? May 7, 2026

Webinar registration: Rising against war economies, for life, health and climate justice May 8, 2026

IMF chief Georgieva warns of ‘much worse outcome’ if conflict drags into 2027, oil hits $125

HRR816. CHAO CENTER-LEFT, HELLO FASCISM

Abuse of women journalists made ‘easier and more damaging’ by AI

Stop Financing Factory Farming

Announcement of the Formation of a Joint Working Committee of the National Minorities of Iran within UNPO

Women in developing countries hardest hit by rising debt burden, UN research finds

It’s burning down there: How shame is keeping SA girls from looking after their sexual health

“We are going to die”: The frontline costs of Uganda’s new US health agreement

Trump is not just slashing maternity aid across the world – the US is also being hit hard

The AI boom is built on the backs of the world’s poorest, most exploited people, UN researchers find

Investing in Midwives is Essential to Improve Sexual and Reproductive Health

WHO Member States agree to extend negotiations on Pathogen Access and Benefit Sharing annex

Hepatitis A virus endemicity and vaccine policy, India

Thailand registers ravidasvir, a simple-to-use and effective antiviral for hepatitis C, expanding treatment options for Thai patients

Malaria vaccine ‘no magic bullet’ for elimination

Senegal’s harsh anti-gay law criminalises HIV infection, hits services

Safeguarding the Hands That Feed Us for a Better Future for All

Justice in priority-setting for research on health and climate change

Methane Emissions From Fossil Fuels Near Record Highs

How Santa Marta Finally Made Fossil Fuel Phase-Out Politically Discussable

Africa’s Youth are Shaping the Continent’s Climate Future

 

 

 

 

 

 

 

Implementing Learning Health Systems in Africa: Strategies, Outcomes, and Real-World Applications for Equitable Access

IN A NUTSHELL
Author's Note 
Learning Health Systems (LHS) offer a framework to continuously improve healthcare by integrating research and practice, making them particularly relevant for addressing health disparities and promoting equitable access in Africa. Implementing LHS in low- and middle-income countries (LMICs) like those in Africa involves adapting existing guidelines, strengthening health systems, and fostering stakeholder engagement to bridge the gap between evidence, policy, and practice. Key outcomes include enhanced health system resilience, improved service delivery, and more equitable access to care, driven by data-informed decision-making and continuous learning

 

By Kirubel Workiye Gebretsadik

Medical Doctor, Ras Desta Damtew Memorial Hospital

Addis Ababa, Ethiopia

By the same Author on PEAH: see HERE

Implementing Learning Health Systems in Africa: Strategies, Outcomes, and Real-World Applications for Equitable Access

 

 

Key Findings

  • Learning Health Systems (LHS) are crucial for accelerating evidence generation and care improvement, especially in contexts with significant health disparities.
  • In Africa, LHS can bridge the evidence-policy-practice gap in primary healthcare, informed by lessons from initiatives like the African Health Initiative.
  • Effective strategies for health care delivery in Africa include fostering strong partnerships, leveraging digital technologies, and building resilient health systems.
  • Implementing LHS requires time for health systems to adapt and learn from their specific contexts, transforming existing operations and functions.
  • Principles of LHS include creating networks of engaged stakeholders and using data to advance patient health, which is vital for equitable access.

Background / Context

Learning Health Systems (LHS) represent a paradigm shift where healthcare delivery generates evidence, and evidence, in turn, continuously improves care. This cyclical process involves stakeholders actively engaged in generating and applying knowledge to enhance patient outcomes and system performance. In Sub-Saharan Africa, where health systems often face challenges related to infrastructure, resources, and equitable access, LHS offers a structured approach to strengthen these systems and ensure high-quality, evidence-informed care.

Strategies for Implementation

Implementing LHS in Africa, particularly for equitable access, involves several key strategies:

  • Adaptation of Guidelines: Health system guidelines and recommendations need to be adapted to local contexts in LMICs to ensure relevance and feasibility.
  • Health System Strengthening (HSS): This involves a holistic approach to improve the capacity of health systems to deliver quality care. Interventions should be evidence-informed and tailored to specific needs.
  • Fostering Partnerships: Collaborations between government bodies, non-state actors, research institutions, and communities are crucial for building resilient health systems and promoting universal health coverage.
  • Leveraging Data and Digital Technologies: The Fourth Industrial Revolution offers opportunities to utilize digital health solutions and data analytics to improve health care delivery and monitoring in Africa.
  • Engaging Stakeholders: Creating a network of motivated stakeholders, including patients, providers, policymakers, and researchers, is fundamental to the successful operation of an LHS.

Outcomes and Benefits

The successful implementation of LHS in Africa can lead to several positive outcomes, particularly concerning equitable access to health care:

  • Improved Health System Performance: Monitoring key measures like health system resilience, effective demand for services, and equitable access can lead to better overall performance.
  • Evidence-Based Policy-Making: LHS facilitates the continuous flow of evidence into policy and practice, ensuring that healthcare decisions are informed by the latest research and real-world data.
  • Enhanced Service Delivery: By identifying what works and adapting interventions, LHS can help deliver high-quality, evidence-informed care, improving health outcomes for populations, especially those in underserved areas.
  • Increased Equity: By systematically evaluating and refining health interventions, LHS can identify and address barriers to access, working towards more equitable distribution of health services and resources.

Real-World Application in Africa

Studies in Sub-Saharan Africa have analyzed how various operational health research projects contribute to building equitable health systems. Initiatives like the African Health Initiative have provided lessons on bridging the evidence-policy-practice gap in primary healthcare settings. These applications demonstrate the need for systems to adapt and learn from their specific contexts to successfully transform existing health system operations and functions.

Practical Takeaway

  • Prioritize Data Infrastructure: Invest in robust data collection, analysis, and sharing mechanisms to fuel the learning cycle of an LHS.
  • Foster Collaborative Ecosystems: Encourage partnerships among diverse stakeholders, including local communities, to ensure policies are context-specific and equitable.
  • Develop Adaptive Policies: Design health policies that are flexible enough to be informed by emerging evidence and real-world outcomes from LHS implementation.
  • Strengthen Local Research Capacity: Support local research and evaluation efforts to generate evidence relevant to African health challenges and solutions.
  • Focus on Primary Health Care: Emphasize LHS implementation in primary health care settings, as this is often the first point of contact for equitable access. 

 

References

A New Horizon: From Broken Systems to Living Communities

IN A NUTSHELL EDITOR's NOTE

A strong piece of advocacy and hope here, just an eyewitness account I’m proud to publish immediately upon submission by the Author, as an acknowledged PEAH contributor, a couple of days ago. 

 As per his terms:

 "...I have been sailing for three weeks with the Global Sumud Flotilla aimed at opening a humanitarian sea corridor to Gaza. We are now in Crete after half of our fleet was intercepted brutally by Israel but we will continue to show we care... In that vein, with a small old throw away (upon interception) /phone, I wrote this article below, which I send for your kind consideration for publication in PEAH" 

 AUTHOR's NOTE

 The Israel occupation forces, with complicit passivity of the European Union, are visible on the horizon. 

Whether this message reaches you or not, know this: the flotilla is not one boat. It is every person who refuses to look away. Every community choosing sharing over hoarding. Every hand that still reaches toward another, across any wall, any sea. Ithaca is not a place. It is a direction. And we are still sailing. 

The flotilla has been intercepted by the Israeli army. What happens next—detention, deportation, violence—I cannot know. But the words above were not written for the moment of arrival. They were written for the moment of setting out. And that moment cannot be erased. 

If you are reading this, the message survived—or someone remembered. 

Tell others: there was a boat. There was a dream. There were people who refused to accept that Gaza must starve in silence, that the sea belongs only to warships, that solidarity is a crime. 

Tell them: the flotilla was not defeated. It was interrupted. But the network of communities, of ecovillages, of shared seeds and shared water and shared stubborn hope—that network is still sailing. On a thousand other boats. In a thousand other hearts. 

"We have a dream." And we will live it into being—whether our bodies survive or not. 

For Gaza. For the earth. For the generations who will read this and know: someone tried

By Juan Garay

Co-Chair of the Sustainable Health Equity Movement (SHEM)

Professor/Researcher of Health Equity, Ethics and Metrics (Spain, Mexico, Cuba, Brazil)

Founder of Valyter Ecovillage (valyter.es)

By the same Author on PEAH:see HERE

A New Horizon: From Broken Systems to Living Communities

 

Somewhere in Greek waters. The flotilla is crossing the same sea that Homer sang of—the journey to Ithaca. Around us, the horizon awaits with the shapes of Israel occupation forces, with complicit passivity of the European Union.

But another world is not only possible. It is already being built.

How a global network of ecovillages, permaculture, and solidarity flotillas could offer a radical alternative to a world defined by financial extraction, media manipulation, and ecological collapse.

In a century marked by cascading crises—genocide in Gaza, accelerating climate breakdown, widening inequity, and the concentration of global power in the hands of a few asset managers—a yet small but growing movement is choosing a different path. It is not waiting for governments or corporations to change course. Instead, it is building from the ground up: self-governing ecovillages, may son be interconnected by flotillas of knowledge and care, rooted in permaculture and guided by the principle of sharing.

There is an ancient echo in the seas we sail. When Homer sang of Odysseus struggling toward Ithaca—not a destination but a return to right relationship with home, with love, with the earth—he was describing what every generation must learn: the journey toward justice is long, the sea is treacherous, and the powers of this world will try to drown you. Today’s Sumud flotilla, heading toward Gaza with medicine and hope, is the same journey. Steadfastness. Refusal to abandon the belief that another shore is possible.

The name “Europe” itself comes from the Phoenician princess Europa, who, in the myth, was abducted from Asia and carried across the sea to Crete. Europa gave her name to a continent that has never quite decided whether it is a refuge or a fortress. For centuries, Europe’s shores have received the shipwrecked and the desperate. And for centuries, Europe has also built walls. Today, the European Union watches in passive complicity as occupation forces intercept boats carrying medicine and hope to Gaza. The continent named for a kidnapped woman now normalizes the kidnapping of hope. But the sea remembers a different possibility: Europa was also a crossing, a connection between continents, a story of movement and encounter—not of closure and exclusion. That older Europe is not dead. It sails with this flotilla.

And Plato knew, long ago, that no society could be fair if a tiny elite accumulated beyond measure. In the Republic, he warned that uncontrolled wealth would destroy the polis—because the rich would become a state within the state, loyal only to their own hoard. That prophecy has come to pass. The major asset managers now hold more power than most nations [2, 3].

Across the traditions that trace their lineage through this same region—from the Galilean hills near Gaza to the deserts of Arabia—a single teaching recurs, too often ignored by the empires and churches and states that claim those traditions as their own. Jesus of Nazareth said: “Love your neighbor as yourself” (Mark 12:31). The Prophet Mohammed, said: “None of you truly believes until he loves for his brother what he loves for himself” (Sahih al-Bukhari). The same words. The same command. Love for the other as one loves for oneself. This is not a sentimental wish. It is the key to peace and justice—and to the harmony of all peoples and all religions. Every wall, every warship, every blockade is a denial of this teaching. Every flotilla, every shared meal, every act of solidarity across enemy lines is its affirmation. Today, “Fortress Europe” builds fences, pushes back boats, criminalizes rescue. The churches and the mosques too often bless the flags of empire rather than the command of the One who made us all. But that command has never been extinguished. It lives in every flotilla.

The numbers, surprisingly, support the dream’s feasibility. Research shows that if humanity reserved two-thirds of the planet’s land for wildlife, and devoted just one-third of the remaining human-share to sustainable, communal permaculture, that would be enough to meet the needs of over 10 billion people—far above this century’s demographic prospects [1]. The obstacle is not scarcity, but maldistribution and a toxic economic model.

The Machinery of Extraction and Control

The current global system is not a neutral failure. It is actively structured to concentrate wealth and power. The return on capital has consistently outpaced economic growth, leading to dynastic wealth accumulation [2]. Speculative financial markets—dominated today by a handful of massive asset managers like BlackRock, Vanguard, and State Street—capture roughly 20–30% of global GDP, not through production but through extraction [3]. This “toxic GDP” behaves like a cancer on the global economy: it fuels inequality, blocks fair redistribution, and drives ecological destruction [3].

Oxfam has repeatedly shown that the top 1% has captured nearly twice as much wealth as the bottom 99% combined [4]. Meanwhile, a UN tax treaty to rein in speculation and tax havens remains blocked by Western powers [3]. The human cost is not abstract: an estimated 16 million excess deaths occur each year—about 30% of all mortality—due to health inequities linked to the dignity gap, the shortfall below the approximately $10 per person per day needed for a decent life [1]. Redistributing just 7% of global GDP—comparable to annual fossil fuel subsidies—would close that gap [1].

The Manipulation of Consent

Media scholars have long described how corporate-owned media manufactures consent for policies that benefit elite interests [5]. Today, that manipulation has reached new intensity. Artificial intelligence is already embedded in military targeting, financial speculation, and global communications—not to advance human wellbeing, but to accelerate dominance. “Without guardrails,” one analysis warns, “we face a world where inequality could deepen from the current ‘one-per-thousand’ plutocracy toward a ‘one-per-million’ technocracy of ruling trillionaires” [6].

The same systems that manipulate democratic processes and spread disinformation also train passivity, transforming citizens into isolated consumers disconnected from land, community, and one another [7].

Breaking the Deal: Genocide and Double Standards

The structural violence of this system is nowhere clearer than in Gaza. UN investigators have documented compelling evidence of genocide, describing Israel’s actions as aiming “to physically destroy Palestinians as a group” [8]. The International Court of Justice has found it plausible that Israel’s acts amount to genocide. Yet the United States and its European allies have vetoed ceasefire resolutions at the Security Council and continued weapons transfers.

This double standard—condemning Russia’s invasion of Ukraine while enabling Israel’s assault on Gaza—has shattered any remaining pretense of universal human rights [3]. The Security Council’s anachronistic veto power, held by World War II victors, overrules the global cry to stop bombing civilians [3].

In response, grassroots resistance has taken new forms. The Sumud Flotilla—Sumud meaning steadfastness in Arabic—is one such initiative: ships carrying humanitarian aid and nonviolent activists, challenging the naval blockade of Gaza. It embodies a refusal to accept forced displacement as normal—and points toward a different logic of connection, not through borders and bombs, but through solidarity and shared risk.

Crossing these Greek waters toward Gaza is to sail the same routes Odysseus took—but in reverse. He sailed away from Troy, toward home. This flotilla sails away from the comfort of Europe, toward the wound of the world. Ithaca was never a place. It was the courage to keep going. And that courage has not faded.

The Hope of Ecovillages

As the old systems reveal their terminal bankruptcy, a growing number of people—especially among the young—are turning toward nature, simplicity, and community. They seek lives that are meaningful, generous, and relational, not competitive and extractive.

Ecovillages—from Europe to Latin America, from Africa to Asia—are one node in what could become a global network [9]. These communities are not escapist enclaves. They are living laboratories of resilience: restoring food sovereignty, practicing participatory governance, regenerating ecosystems, and reducing dependence on an alienating global market [10].

Importantly, they are not anti-technology. Open-source software and digital commons allow these communities to share knowledge, collaborate on global public goods, and counteract the manipulative effects of proprietary platforms [10]. They offer young people something increasingly rare: a tangible sense that their actions matter, that dignity can be defended collectively, and that another way is possible.

Flotillas of Cross-Pollination

The vision extends beyond individual ecovillages. A global network of sovereign, interrelated communities—rooted in their territories but open to one another—could be interconnected by flotillas. Not military vessels, but boats carrying seeds, stories, music, tools, and healing practices. These flotillas would cross-pollinate knowledge, culture, and existential visions, building solidarity without domination.

Just as the Sumud Flotilla challenges the siege of Gaza, a network of solidarity flotillas could challenge the broader siege of the imagination: the belief that there is no alternative to capitalism, nationalism, and ecological suicide.

A Feasible Utopia

What makes this dream tangible is its grounding in measurable realities. The research shows that below a dignity threshold of about $10 per person per day, no country has ever achieved the best feasible levels of health. Above an excess threshold of around $50 per person per day, no country has respected planetary boundaries, and health gains plateau. The GDP above that excess level—roughly 60% of world GDP—is effectively waste, responsible for 90% of carbon emissions [1].

If that waste were redirected, simpler lives in terms of production and consumption could reduce emissions below the ethical threshold of about 1.3 tons of CO2 per person annually (to keep warming under 2°C) or even 0.3 tons (for 1.5°C). At current rates, excess emissions are projected to cause 218 million premature deaths this century, mostly in low-polluting countries [11].

But the alternative—a global network of ecovillages practicing sustainable permaculture on just one-third of the human-share of land—would not only prevent that catastrophe. It would enable the best feasible level of health for all, while leaving two-thirds of the planet to wildlife [1].

Choosing Life

This is called a “global, peaceful revolution” [3]. It does not expect to replace existing institutions overnight. But it rejects the idea that violence and extraction are inevitable.

As one manifesto puts it: “We have a dream that humanity will remember that all life is sacred, and that humans are part of the web of life—not its owners, not its masters. We have a dream of communities that regenerate ecosystems instead of exhausting them… We have a dream of a global network of sovereign, interrelated communities—rooted in their territories, open to one another, sharing knowledge, seeds, and solidarity for the common good” [7].

In an age of genocide, inequity, and ecological breakdown, that dream is not a retreat from reality. It is the most realistic path left to preserve life, health, and meaning in the century ahead.

 

References

[1] Garay, J. (2023). “Towards a WISE – Wellbeing in Sustainable Equity – New Paradigm for Humanity.” PEAH – Policies for Equitable Access to Health.

[2] Piketty, T. (2014). Capital in the Twenty-First Century. Harvard University Press.

[3] Garay, J. (2024). “Restoring Broken Human Deal.” PEAH.

[4] Oxfam International. (2024). Inequality Kills: The staggering human cost of extreme wealth.

[5] Chomsky, N. (2002). Media Control: The Spectacular Achievements of Propaganda. Seven Stories Press.

[6] Garay, J. (2025). “The Inequity Risks of AI When the Global Good Is Not the Goal.” PEAH.

[7] Garay, J. (2026). “WE HAVE A DREAM.” PEAH.

[8] Albanese, F. (2024). Report of the Special Rapporteur on the situation of human rights in the Palestinian territories occupied since 1967. UN Human Rights Council.

[9] Valyter Ecovillage. (n.d.). valyter.es

[10] Garay, J. (2026). “Health, Hope, and Resistance in an Age of War, Inequity, and Ecological Breakdown.” PEAH.

[11] Garay, J. (2024). “Human Ethical Threshold of CO2 Emissions and Projected Life Lost by Excess Emissions.” PEAH.

 

News Flash 663: Weekly Snapshot of Public Health Challenges

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

Mediterranean rainbow wrasse (Coris julis)

News Flash 663

Weekly Snapshot of Public Health Challenges

 

The System Isn’t Stalling. It’s Being Rewritten: An Insider View from CPD59 (and Beyond!)   by Levi Singh 

Neoliberal Epidemics, part 2  “Deadly Austerity Past and Future”  by Ted Schrecker 

From Evidence to Earth Systems: Reconstructing Health Guidelines as Instruments of Planetary Governance in an Era of Climate Instability  by Kalolo Chitembo 

Podcast: Is it the end of the NGO as we know it?

Africa Moves to Unify on Global Health Reforms #WHSNairobi2026

Conversations for Change: Shaping the Future of Essential Medicines (Hybrid Symposium) ITM community and partners in dialogue with The Lancet Commission on accelerating the progress on essential medicines. Register to join! 12/06/2026

Webinar registration: Feeding Profits, Starving People: How Food Financialization Is Eating The Planet May 6, 2026

Feeding Profits, Starving People: How Food Financialization Is Eating The Planet

Gender equality and the climate crisis: champions and backsliders

e-book: “The Clinical Board: In What Ways Can Independent Directors in Indian Pharma and Healthcare Move from Compliance Theatre to Scientific Accountability: A Practical Framework for Boards That Must Bridge the Lab, the Law, and the Boardroom.”

HRR815. HEALTH OVER PROFIT EVERYWHERE! HOW TO OVERCOME THE PRIVATIZATION OF HEALTHCARE SYSTEMS

People’s Health Dispatch Bulletin #117: World Health Day 2026: amid war on health, internationalism and solidarity offer path forward

A South Sudan community is denied aid as government and opposition blame each other

Webinar registration: From Pilot to Policy: Scaling DigiCare4You for Better Noncommunicable Disease Care May 19, 2026

Child vaccine catch-up drive on course to hit target: UN

For Every Generation, Vaccines Work: Immunization Across the Life Course

A shot of urgency: Five key pathways to reach more people with lifesaving vaccines

EMA launches new advisory group on vaccine confidence

Tackling social media influencers spreading rumours on the malaria vaccines

Malaria Funding Crisis and Drug Resistance Compel African Investment

Climate change and malaria control in Africa: country experiences and strategic responses

Dr Fatimata Bintou Sall: Optimising access to malaria vaccines

How do you solve a problem like malaria?

Australia becomes the 30th country to eliminate trachoma as a public health problem

Cholera Deaths Nearly Doubled in Africa in 2025. Cuts to Aid May Have Contributed

Efforts to eliminate hepatitis delivers gains but more action needed to meet 2030 targets

Two-thirds of global hunger concentrated in 10 conflict-hit countries

World food systems ‘pushed to the brink’ by extreme heat, UN warns

First ever talks to ditch fossil fuels as UN deadlock deepens

Record European Heatwaves Shrink Glaciers and Diminish Snow Cover in 2025

 

 

 

 

 

 

 

 

 

 

From Evidence to Earth Systems: Reconstructing Health Guidelines as Instruments of Planetary Governance in an Era of Climate Instability

IN A NUTSHELL
Author's Note 
Health systems are increasingly recognized as both victims and drivers of planetary destabilization, yet the architecture of evidence-based medicine remains structurally blind to environmental externalities. This paper advances a novel conceptual and policy framework that integrates planetary health into clinical and public health guideline systems through an expanded Evidence-to-Decision architecture. Drawing on recent global health governance debates, climate–health risk modeling, and emerging methodologies such as lifecycle assessment and carbon-utility analysis, the study reframes guidelines as instruments of macroprudential policy with direct implications for sovereign risk, fiscal stability, and climate resilience.

Positioning One Health as the operational bridge between ecological systems and human health, the paper proposes a multi-scalar governance model linking clinical decision-making to national and global risk architectures. In doing so, it argues that the failure to internalize planetary constraints within guideline development constitutes a systemic mispricing of health interventions, with cascading consequences for equity, sustainability, and economic stability.

The paper concludes by outlining actionable pathways for low- and middle-income countries—particularly in Sub-Saharan Africa—to assume global leadership in climate-informed health governance, positioning guideline reform as a strategic lever for resilience, equity, and geopolitical agency

 By Kalolo Chitembo

Crisis Expert/ Emergency Medicine Specialist/ Health Economist/ Global Health Advocate/ Climate and ONE HEALTH Researcher

Zambia

By the same Author on PEAH: HERE

From Evidence to Earth Systems

Reconstructing Health Guidelines as Instruments of Planetary Governance in an Era of Climate Instability

 

Introduction: The Invisible Fault Line in Global Health Governance

Modern health systems operate on a paradox: they are designed to protect life while contributing materially to ecological degradation. The global healthcare sector accounts for approximately 4.4–5% of greenhouse gas emissions, a footprint that rivals major industrial economies. Yet, the epistemological core of health decision-making—clinical and public health guidelines—remains detached from planetary constraints.

This disconnect represents more than a technical oversight. It is a governance failure embedded within the architecture of evidence itself. Guidelines, often perceived as neutral clinical instruments, function in reality as silent regulators of resource allocation, technology adoption, and population health trajectories. Their omission of environmental externalities systematically biases decision-making toward short-term clinical gains at the expense of long-term system resilience.

In an era defined by climate instability, biodiversity collapse, and emerging zoonotic risks, this omission is no longer tenable. The question is no longer whether planetary health should be integrated into guidelines, but how rapidly governance systems can evolve to reflect this reality.

Theoretical Foundation: From Evidence-Based Medicine to Planetary Evidence Systems

Evidence-based medicine (EBM) has historically privileged clinical efficacy, safety, and cost-effectiveness. While frameworks such as GRADE have expanded to include equity and feasibility, they remain insufficient for capturing non-linear, cross-sectoral risks inherent in planetary systems.

Recent advances in planetary health science, ecological economics, and climate risk modeling challenge the boundaries of conventional evidence hierarchies. These disciplines reveal that health outcomes are inseparable from:

Climate variability and extreme events

Biodiversity integrity

Food and water system stability

Anthropogenic environmental change

The integration of these domains necessitates a transition toward what may be termed Planetary Evidence Systems (PES)—a multidimensional epistemology in which clinical, environmental, and socio-economic data converge within a unified decision architecture.

At the core of this transformation is the recognition that:

Evidence is not merely descriptive—it is constitutive of policy reality.

Methodological Innovation: Extending Guideline Architecture

Expanding the Evidence-to-Decision (EtD) Framework

This paper proposes the introduction of a fourth domain within guideline development:

Clinical effectiveness

Economic efficiency

Equity and feasibility

Planetary impact (new domain)

This additional domain systematically incorporates:

Lifecycle environmental impacts of interventions

Carbon intensity of care pathways

Ecological co-benefits and harms

Long-term system resilience implications

Analytical Tools for Integration

Emerging methodologies enable operationalization:

Lifecycle Assessment (LCA): Quantifies environmental burden across supply chains

Carbon-Utility Analysis: Extends cost-effectiveness analysis to include emissions

Integrated Assessment Models (IAMs): Link health outcomes with climate scenarios

Digital Surveillance Systems: Real-time monitoring of climate-sensitive disease patterns

Collectively, these tools transform guidelines into dynamic, data-responsive governance instruments.

One Health as the Operational Bridge

The One Health paradigm provides the institutional and conceptual infrastructure necessary for integration. By linking human, animal, and environmental health, it transcends sectoral silos and aligns with planetary health principles.

This paper advances a One Health Nexus Governance Model, characterized by:

Cross-ministerial coordination (health, environment, agriculture, finance)

Integration of zoonotic surveillance with climate risk analytics

Alignment with national adaptation plans and climate commitments

Embedding within primary care and community health systems

In this architecture, guidelines become interfaces between science, policy, and ecosystems.

Macroprudential Implications: Health Guidelines as Instruments of Sovereign Stability

A critical innovation of this paper is the elevation of health guidelines into the domain of macroprudential governance.

Failure to integrate planetary health considerations results in:

Increased burden of climate-sensitive diseases

Escalating healthcare costs

Reduced labor productivity

Heightened fiscal pressure on governments

Conversely, climate-informed guidelines act as:

Preventive investments in national resilience

Risk mitigation tools within sovereign balance sheets

Stabilizers of long-term economic growth trajectories

This reframing aligns health policy with the logic of central banking, fiscal policy, and global financial governance, positioning ministries of health as key actors in national risk architecture.

Current Affairs and Global Policy Momentum

Recent developments underscore the urgency of this transformation:

Intensifying climate shocks across Africa, including droughts and flooding, are reshaping disease patterns and health system demands.

Global health governance is undergoing fragmentation, with shifting multilateral commitments and renewed debates on institutional legitimacy.

The World Health Summit agenda increasingly emphasizes climate–health integration, digital transformation, and system resilience.

Major financing institutions (e.g., World Bank, regional development banks) are embedding climate risk into health investment frameworks.

These dynamics create a policy window for structural reform—particularly for emerging economies to shape global norms.

Strategic Positioning for Sub-Saharan Africa

Sub-Saharan Africa, often framed as vulnerable, holds a unique opportunity to act as a norm entrepreneur in planetary health governance.

By integrating planetary considerations into guideline systems, countries such as Zambia can:

Leapfrog legacy systems

Align health policy with climate adaptation financing

Strengthen regional leadership within SADC and the African Union

Attract strategic partnerships with global health and climate institutions

This represents not merely adaptation, but geopolitical repositioning through policy innovation.

Discussion: The Political Economy of Transformation

Despite its technical feasibility, integration faces barriers:

Institutional inertia within guideline bodies

Limited interdisciplinary capacity

Fragmented data ecosystems

Short-term political incentives

Addressing these challenges requires:

High-level political commitment

Investment in data and analytical infrastructure

Strategic framing linking health to economic and national security priorities

Ultimately, the transition is not only scientific—it is profoundly political.

Conclusion: Rewriting the Rules of Evidence

Health guidelines are among the most powerful yet under-recognized instruments in global governance. In their current form, they encode a narrow conception of value that is misaligned with planetary realities.

Integrating planetary health into guideline systems is therefore not a technical refinement—it is a paradigm shift in how societies define, measure, and govern health itself.

In an era where climate instability is redefining risk, resilience, and sovereignty, the future of global health will be determined not only by innovation in medicine, but by innovation in the architecture of evidence.

The System Isn’t Stalling. It’s Being Rewritten: An Insider View from CPD59 (and Beyond!)

IN A NUTSHELL
Editor's note
Find an op-ed piece here on the recently concluded  59th Session of the UN Commission on Population and Development, whereby the theme of the Commission was on population, technology and research in the context of sustainable development and a major sticking point in the negotiations (closed without outcome) was tech transfer between the global North and global South. 

As a topic with extremely important implications for people in today’s world arena, I am pleased to share the piece within PEAH network and beyond, while readers are invited to comment on its content and suggestions. 

This debrief article reflects the personal views of the author, based on professional experience, and does not represent the official positions of any government delegation or institution

By Levi Singh
Regional Policy Officer at SRHR Africa Trust

Johannesburg, South Africa

The System Isn’t Stalling. It’s Being Rewritten

An Insider View from CPD59 (and Beyond!)

 

I have spent enough time in multilateral rooms to recognise the difference between a difficult negotiation and a hollow one. Having now supported twelve sessions of the United Nations Commission on Population and Development, I do not say this lightly.

CPD59 was not difficult in the way these multilateral processes are meant to be. It was something else entirely. The zero draft, the foundation for negotiations, was notably weak when first circulated by the Chair, though it was meaningfully improved through the concerted efforts of Member States. By the time Revision 2 of the draft resolution emerged, it contained elements many of us could accept, or at the very least live with, as is the nature of political compromise. Yet even then, very little of what makes multilateralism function, compromise, explanation, reciprocity, and movement, was genuinely on offer.

That distinction matters.

Because when a system stops negotiating in good faith, it does not simply stall. It begins, quietly and incrementally, to rewrite itself.

From the outside, the breakdown will be framed as familiar. Divergence between North and South. Sensitivities around language. A complex geopolitical context. All true, and all insufficient.

Inside the room, the fault lines were sharper.

Take technology transfer. For many Global South delegations, this is not an abstract principle. It is foundational to any credible pathway toward development. South Africa and others grounded their position in existing global commitments that recognise the diffusion of technology and know-how as central to economic growth and sustainable development. That should not have been controversial. Especially since we have a UN General Assembly consensus-based resolution supporting this, as recently as 2024 (A/RES/79/216).

Yet it was treated as negotiable in a way that exposed a deeper reluctance, particularly from parts of the Global North, to move beyond tightly controlled, voluntary frameworks that preserve asymmetry (and entrench inequality – remember SDG10?!) while continuing to speak the language of partnership.

That is not a mere technical disagreement. It is a political choice.

A similar dynamic played out in debates around “the family”. Attempts to advance a singular, ideologically loaded definition were not simply about wording. They were about which and whose realities are recognized and validated in global policy. For those of us coming from contexts shaped by colonialism, apartheid, the AIDS epidemic, migration, and economic exclusion, the insistence on a narrow, nuclear framing is not only inaccurate but also dismissive of our lived realities.

Multigenerational households. Child-headed households. Extended kinship systems. These are not novel cases. They are the social infrastructure of entire societies. Ignoring that in policy language is not neutral. It is exclusion by intention and design.

But these visible tensions only tell part of the story.

What is less visible, and far more consequential, is the extent to which multilateral negotiation is now being shaped outside multilateral spaces.

There is a growing alignment between what happens in rooms like CPD and what is being pursued through bilateral channels. The shift toward “trade not aid”, the quiet expansion of bilateral health agreements in the wake of eliminated funding through mechanisms like PEPFAR, and the parallel effort to consolidate political blocs around initiatives such as the Geneva Consensus Declaration and PROTEGO, all of this sits in the background of what we are seeing play out in the basement conference rooms in New York.

None of it is formally on the table; however, all of it shapes the table.

It is not unreasonable to assume that positions taken in multilateral negotiations are increasingly linked to incentives and pressures applied elsewhere. Preferential access to critical minerals for the production of semiconductors and microchips (ask your nerdy friends!). Funding streams. Strategic political alignment. In that environment, consensus is not just negotiated. It is conditioned.

That is what transactional multilateralism looks like in practice.

And it explains why spaces like the CPD are becoming harder to navigate. Not because disagreement has increased, but because the terms of engagement have shifted.

The outcome, or lack thereof, reflects that shift. As noted in the Global South Coalition for SRHR and Development Justice statement, this is not simply a missed resolution. It is a drift toward geopolitical positioning over collective well-being.

The consequences are immediate.

When there is no agreed outcome, there is no shared political direction. When there is no direction, national and regional implementation fragments. And when implementation fragments, the burden does not fall on those negotiating texts. It falls on those who depend on what those texts are meant to enable, empower, and support.

Each year, hundreds of thousands of women die from preventable causes related to pregnancy and childbirth. Millions more lack access to contraception, to safe health care, including abortion services, to basic autonomy over their own bodies and lives. These are not statistics that sit on the margins of development; rather, they are indicators of whether development is happening at all.

The CPD, anchored in the International Conference on Population and Development Programme of Action, remains one of the few spaces where these issues are addressed in an integrated way. Undermining that space, whether through inaction or design, has direct implications for delivery in communities.

It also raises serious questions about institutional direction.

Proposals to merge United Nations Population Fund with UN Women are often framed as efficiency gains. From a distance, that may sound reasonable. Up close, it risks collapsing distinct mandates at precisely the moment when technical focus and programmatic clarity are most needed. Efficiency should never come at the cost of effectiveness.

Looking ahead, the sequencing should concern anyone paying attention.

CPD60 will focus on poverty eradication. In another moment, that might have been unifying. In this one, it risks becoming another site of contestation, particularly as conversations turn toward debt relief, financial justice, and the structural conditions that enable and sustain inequality (Hello, Stiglitz!).

Beyond that sits 2027, and what is likely to be the final global review of the United Nations Sustainable Development Goals before 2030. A moment intended as a final course correction in this “decade of action for the SDGs” now risks becoming something more subdued in the shadow of UN80 reforms. We have roughly 66 months left.

That is not a long time. It is certainly not enough to pretend that multilateral processes alone will deliver outcomes.

And then there is the question we are not yet asking loudly enough. What comes after 2030?

Because the truth is this. The post-2030 development architecture is already being shaped. Not only through formal negotiations, but through the behaviours we are normalising now. If we accept a version of multilateralism that is increasingly transactional, increasingly selective, and increasingly detached from decades-old rights-based commitments, then that is the system we will carry forward.

And it will not be a people-centred one.

At the heart of the current framework sit the principles of people, planet, peace, prosperity, and partnerships. In practice, what is most at risk is not the language, but the intent. Particularly the idea of solidarity.

Without solidarity, partnerships become conditional. Without solidarity, development becomes uneven by design. Without solidarity, inequality is not reduced; it is rationalised as yet another indicator and target.

So, we are left with a choice, and it is a more immediate one than many are willing to admit.

We can continue along this path, preserving the appearance of multilateralism while hollowing out its substance, allowing an international order to consolidate that serves the interests of a few.

Or we can choose to correct course. Deliberately. Urgently. And with a level of honesty that reflects the stakes.

The United Nations still offers the space to do that.

But after twelve CPDs, I am less convinced that space, on its own, is enough.

Because if processes continue to fracture, outcomes will follow.

And when outcomes fail, it is not institutions that absorb the cost.

It is people.