Civil society organisations and global health initiatives: problems of legitimacy

Civil society organisations (CSOs) have a prominent role in global health initiatives such as The Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) and, in the United States, the President's Emergency Plan for AIDS Relief (PEPFAR). They are increasingly consulted by international organisations and, in some cases like the Global Fund, are involved in decision-making. They are also increasingly seen as crucial agents in delivering health interventions on the ground. Some donors prefer to channel funds through CSOs in developing countries than through perceived to be corrupt or inefficient government agencies. This paper examines this growing role and the arguments put forward to justify their increasing influence, particularly in HIV/AIDS initiatives. It analyses the main challenges to CSOs' legitimacy and outlines key responses to these challenges. It concludes by suggesting a number of research priorities that might help to evaluate the impact of CSOs in global health initiatives.     

Interfacility Transport of Patients With Decompression Illness: Literature Review andConsensus Statement

Objective. Decompression illness (DCI) is a potentially lethal complication of diving andmay occur far from hyperbaric facilities. The need for prompt transport to a hyperbaric facility often involves air medical transport, but this may exacerbate DCI. The authors reviewed available literature to establish evidence-based transport strategies utilizing safe altitudes for patients, with DCI. Methods. MEDLINE, EMBASE, andmaterials from organizations with expertise in diving medicine were searched for the following terms: decompression sickness, caisson disease, hyperbaric oxygenation, depth intoxication, or diving. Two reviewers independently selected relevant citations involving patients with DCI andair medical transport for review andconsensus statement development by an expert working group. Results. A total of 341 citations were identified, and53 unique citations were reviewed. Nine relevant citations were selected for consensus statement development. There were no clinical trials or prospective cohort studies. Only two retrospective case series, including nine patients, specifically examined the effect of altitude on patients with DCI during transport. No symptom recurrence occurred when the cabin altitude remained within 500 feet of ground level. Seven citations were either letters or statements of expert opinion, recommending a maximum cabin altitude of 500–1000 feet (152–305 meters). Conclusions. The working group identified the paucity of clinical studies andevidence-based recommendations for air medical transport of patients with DCI. Transport selection should be based on minimizing total transport time and, when transporting by air, ensuring that a cabin altitude of the transporting vehicle does not exceed 500 feet (152 meters) above the departure point.