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In his perspective "Navigating between stealth advocacy and unconscious dogmatism: the challenge of researching the norms, politics and power of global health," Ooms argues that actions taken in the field of global health are dependent not only on available resources, but on the normative premise that guides how these resources are spent. This comment sets out how the application of a predominately biomedical positivist research tradition in global health, has potentially limited understanding of the value judgements underlying decisions in the field. To redress this critical social science, including health policy analysis has much to offer, to the field of global health including on questions of governance.

In his perspective "Navigating between stealth advocacy and unconscious dogmatism: the challenge of researching the norms, politics and power of global health," Ooms argues that actions taken in the field of global health are dependent not only on available resources, but on the normative premise that guides how these resources are spent. This comment sets out how the application of a predominately biomedical positivist research tradition in global health, has potentially limited understanding of the value judgements underlying decisions in the field. To redress this critical social science, including health policy analysis has much to offer, to the field of global health including on questions of governance.

The Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund or GFATM) is a private public partnership aimed at leveraging and providing funding for the three focal diseases outlined in its title. Set up in 2002, the fund was part of a new 'breed' of players in the field of global health, combining skills from bilateral and multilateral agencies with private sector and civil society. Highly innovative in its structure and funding model, the Global Fund's secretariat in Geneva provides grants directly to one or more organisations – not just governments – in recipient countries. Despite great successes, including scaling up treatment for AIDS to reach 4.2 million people, the fund has been the subject of intense debate. This includes discussion of its impact on health systems and allegations of financial irregularities among recipients in four countries. The organisation has now emerged with a new strategy, funding model and executive director. This paper charts its history, discusses some of the challenges faced, drawing on fieldwork conducted by the author in 2007–08, and reflects on recent changes and the road ahead.

Die heutige hochmobile und vernetzte Welt bietet unzählige Möglichkeiten für die rasche Ausbreitung von Infektionskrankheiten, wie die aktuelle COVID-19-Pandemie zeigt. Ein Ausbruch oder eine Epidemie in einem Teil der Welt kann nur wenige Stunden davon entfernt sein, an einem anderen Ort zu einer unmittelbaren Bedrohung zu werden. Seit den 1970er-Jahren werden neu auftretende Infektionskrankheiten mit einer beispiellosen Rate von einer oder mehreren pro Jahr identifiziert. Heute gibt es fast 40 Krankheiten, die vor einer Generation noch unbekannt waren. Darüber hinaus hat die Weltgesundheitsorganisation (WHO) in den letzten 5 Jahren weltweit mehr als 1100 epidemische Ereignisse verifiziert. Die Infektionserreger können jede Grenze überwinden. Epidemien bedrohen die Gesundheit der Bevölkerung, erzeugen großes menschliches Leid und bergen ein enormes wirtschaftliches Schadenspotenzial. Ihre Folgen tragen besonders in ressourcenarmen Ländern zur sozialen und politischen Instabilität bei und können Fluchtbewegungen verstärken. Ebenso führen soziale und politische Instabilität zu Umständen, die das Auftreten neuer Erreger sowie die Verbreitung von Infektionskrankheiten fördern. Seit der Ebolakrise 2014/2015 in Westafrika, und spätestens durch die aktuelle COVID-19-Pandemie, ist deutlich geworden, wie eng der nationale mit dem internationalen Gesundheitsschutz zusammenhängt. Eine internationale Perspektive ist daher ein wesentlicher Bestandteil einer nationalen Gesundheitspolitik. Dies spiegelt sich auch in den Erklärungen der Bundesregierung anlässlich des G‑7-Gipfels 2015 in Elmau sowie des G‑20-Gipfels in Hamburg 2017 wider. Deutschland übernimmt darin künftig eine strategische und gestaltende Rolle innerhalb der Staatengemeinschaft zur langfristigen Stärkung von Gesundheit im internationalen Kontext. Für die Umsetzung dieses Ziels hat das Bundesministerium für Gesundheit die Einrichtung eines "Zentrums für Internationalen Gesundheitsschutz – ZIG" am Robert Koch-Institut (RKI) veranlasst. "Ein leistungsfähiges ...

OBJECTIVE: To investigate the magnitude and characteristics of medical tourism in Thailand and the impact of such tourism on the Thai health system and economy. METHODS: In 2010, we checked the records of all visits to five private hospitals that are estimated to cover 63% of all foreign patients. We reviewed hospital records of foreign patients and obtained data on their countries of origin, diagnoses and interventions. We surveyed 293 medical tourists to collect demographic characteristics and information on their expenditure and travelling companions. To help understand the impact of medical tourism on the Thai health system, we also interviewed 15 hospital executives and 28 service providers from the private hospitals. FINDINGS: We obtained 911,913 records of hospital visits, of which 324,906 came from 104,830 medical tourists. We estimated that there were 167,000 medical tourists in Thailand in 2010. Of the medical tourists who attended our study hospitals, 67,987 (64.8%) came from the eastern Mediterranean region or Asia and 109,509 (34%) of them were treated for simple and uncomplicated conditions - i.e. general check-ups and medical consultations. The mean self-reported non-medical expenditure was 2750 United States dollars. According to the hospital staff interviewed, medical tourism in 2010 brought benefits to - and apparently had no negative impacts on - the Thai health system and economy. CONCLUSION: We estimate that the total number of medical tourists visiting Thailand is about 10% of previous national government estimates of 1.2 million. Such tourists appear to bring economic benefits to Thailand and to have negligible effects on the health system.

BACKGROUND: The resolution adopted in 2006 by the World Health Organization on international trade and health urges Member States to understand the implications of international trade and trade agreements for health and to address any challenges arising through policies and regulations. The government of Maldives is an importer of health services (with outgoing medical travelers), through offering a comprehensive universal health care package for its people that includes subsidized treatment abroad for services unavailable in the country. By the end of the first year of the scheme approximately US$11.6 m had been spent by the government of Maldives to treat patients abroad. In this study, affordability, continuity and quality of this care were assessed from the perspective of the medical traveler to provide recommendations for safer and more cost effective medical travel policy. RESULTS: Despite universal health care, a substantial proportion of Maldivian travelers have not accessed the government subsidy, and a third reported not having sufficient funds for the treatment episode abroad. Among the five most visited hospitals in this study, none were JCI accredited at the time of the study period and only three from India had undergone the National Accreditation Board for Hospitals (NABH) in India. Satisfaction with treatment received was high amongst travelers but concern for the continuity of care was very high, and more than a third of the patients had experienced complications arising from the treatment overseas. CONCLUSION: Source countries can use their bargaining power in the trade of health services to offer a more comprehensive package for medical travelers. Source countries with largely public funded health systems need to ensure that medical travel is truly affordable and universal, with measures for quality control such as the use of accredited foreign hospitals to make it safer and to impose measures that ensure the continuity of care for travelers.

BACKGROUND: In resource-constrained health systems medical travel is a common alternative to seeking unavailable health services. This paper was motivated by the need to understand better the impact of such travel on households and health systems. METHODS: We used primary data from 344 subsidized and 471 non-subsidized inbound medical travellers during June to December 2013 drawn from the North, Centre and South regions of the Maldives where three international airports are located. Using a researcher-administered questionnaire to acquire data, we calculated annual out-of-pocket (OOP) spending on health, food and non-food items among households where at least one member had travelled to another country for medical care within the last year and estimated the poverty head count using household income as a living standard measure. RESULTS: Most of the socio demographic indicators, and costs of treatment abroad among Maldivian medical travellers were similar across different household income levels with no statistical difference between subsidized and non-subsidized travellers (p value: 0.499). The government subsidy across income quintiles was also similar indicating that the Maldivian health financing structure supports equality rather than being equity-sensitive. There was no statistical difference in OOP expenditure on medical care abroad and annual OOP expenditure on healthcare was similar across income quintiles. Diseases of the circulatory system, eye and musculoskeletal system had the most impoverishing effect - diseases for which half of the patients, or less, did not receive the public subsidy. Annually, 6 and 14% of the medical travellers in the Maldives fell into poverty ($2 per day) before and after making OOP payments to health care. CONCLUSION: Evidence of a strong association between predominant public financing of medical travel and equality was found. With universal eligibility to the government subsidy for medical travel, utilization of treatment abroad, medical expenditures abroad and OOP expenditures on health among Maldivian medical travellers were similar between the poor and the rich. However, we conclude mixed evidence on the linkages between public financing of medical travel and impoverishment which needs to be further explored with comparison of impoverishment levels between households with and without medical travel.

Assumptions surrounding the origins of Covid-19, the relationship between human mobility and the spread of the virus, and the pressure that the pandemic has placed on communities, have exacerbated xenophobic tensions globally, including in South Africa, a country long-associated with xenophobia. Previous research exploring how the South African media frames migration, and research investigating the framing of migration during Covid-19 in other contexts, has found that the media tends to frame migrants in terms of (un)deservingness and blame them for the spread of disease. Our findings, however, identify different concerns. This article discusses findings from a 12-month study exploring how migrant and mobile populations in South Africa were framed in the media as the pandemic developed during 2020. A news aggregator - Meltwater - was used to scrape the internet for English language text-based media published globally in 2020 that met a search with key terms Migration, Covid-19, and South Africa. A total of 12,068 articles were identified and descriptively analysed. Informed by previous approaches, a framing analysis was then undertaken of a sample of 561 articles. Findings illustrate how articles published by outlets based in the US and UK have a far greater reach than locally or regionally produced articles, despite local and regional outlets publishing far more consistently on the topic. Consistent and sympathetic engagement with issues of migration by South African publications was seen across 2020 and suggests that those writing from the region are aware of the realities of migration and mobility. Findings show that rather than centring migrants as the locus of blame for failures of the South African state - as has been done in the past - the state and its failure to adequately respond to both Covid-19 and migration are now being clearly articulated by media.