The year 2015 began on a gloomy note for Indonesia following the crash of AirAsia flight QZ8501 in the Karimata Strait. Search and rescue efforts for the 162 passengers and crew of the aircraft, bound for Singapore from Surabaya on the morning of Dec. 28, have been going on for a week.

President Joko "Jokowi" Widodo ordered the National Search and Rescue Agency (Basarnas) to prioritize retrieval of the bodies. Surabaya Mayor Tri Rismaharini stayed with the waiting passengers' families at the Juanda Airport crisis center to lend them support.

The accident was the country's worst last year.

In the past decade, the growth of budget airlines has helped connect people and our 13,000 islands. However, the latest accident has raised questions once again over our aviation safety.

Safety remains an issue throughout the country's transportation system, especially land transportation. National Police data recorded that 26,484 people were killed in traffic accidents in 2013. The figure is lower than three years earlier of 31,234 people.

Although the police run regular campaigns on traffic safety, many road users continue to ignore traffic rules. However, transportation is also about connectivity from one point to another. The government's plan to build more roads and toll roads is widely welcomed despite calls to use public transportation.

Transportation is just one of many things that the Jokowi administration will have to concentrate on this year.

The government's decision to cap the fuel subsidies — effective from New Year's Day — should mean more funds for other sectors, especially health care and education. Increasing fuel prices was a far from popular move, with the public initially protesting but many finally accepting that the fuel subsidies had to be allocated elsewhere for the greater good.

The Healthcare and Social Security Agency (BPJS Kesehatan) program for all citizens — including white-collar workers in the private sector starting this month — seems ideal. However, low participation and compliance in paying premiums will remain two major problems for the BPJS Kesehatan.

In the education sector, the government's decision to return to the 2006 curriculum starting this month has brought relief to many teachers and parents. They also welcomed the ministry's decision to end the function of the national exam as the sole determinant of student graduation.

Both decisions were deemed landmarks for the country's education system. Culture and Elementary and Secondary Education Minister Anies Baswedan said the government expected to see better exams this year. He also revealed that eight components were used to qualify the success of the educational system, which included the exams, teachers, learning materials and school infrastructure.

Further work for the Jokowi administration is the fight against corruption. Despite the Corruption Eradication Commission's (KPK) never ending efforts to investigate big graft cases, corruption is still rampant in the country.

The KPK has been criticized for not finishing its investigations into big cases. As KPK chairman Abraham Samad said, one major reason for this is limited human resources. To cope with the challenges, the KPK has revamped its top posts' job descriptions, namely enforcement, prevention, data and information management and internal monitoring and public complaints.

Another issue that remains a pebble in Jokowi's shoe is religious tolerance and human rights. Somehow the way the government deals with these ongoing issues has yet to answer the real problems. We want to hear the good news that congregations are allowed to hold regular services in their churches; that Ahmadis can return to their homes; and that acts of violence against civilians by authorities have been stopped.

On top of all these challenges Jokowi still needs to make peace with members of the House of Representatives. Supported by the Indonesian Democratic Party of Struggle (PDI-P) in last year's presidential election, the party, unfortunately, could not easily dominate the House as it faced strong resistance from the Red-and-White Coalition.
Even though the Red and White — spearheaded by the Golkar Party, which supported Jokowi's rival Prabowo Subianto — is losing supporters, it still has a grip on the House. The United Development Party (PPP) was the first to declare its departure from the coalition following the party's split into the camps of Suryadharma Ali and former party secretary-general Muhammad "Romy" Romahurmuziy.

Later, it was Golkar's turn to be rocked by infighting. The country's oldest political party saw major internal division after a group of the party's youth members, supporters of former coordinating people's welfare minister Agung Laksono, stormed Golkar headquarters in West Jakarta and attacked members of the opposing faction.
Golkar has known infighting before, but it had never experienced violence and now the party has effectively split in two: one faction led by incumbent chairman Aburizal Bakrie and one by deputy chairman Agung.

Jokowi and the PDI-P-led coalition need to use every means available to control the House so that the government's programs can be implemented properly and pending bills can be deliberated smoothly.

For all of the shortcomings under Jokowi-Kalla, the world has been impressed by their victory in the presidential election, Jokowi's speech in Beijing and how the government is handling the AirAsia crash. To improve the economy and governance of the 240 million population is not easy. Just as Jokowi said in his speech after announcing his Cabinet: our option is only to work, work, work. 

source: http://www.thejakartapost.com

Yes, according to a comment in one of the world's leading health journals, The Lancet.

The Associated Press has a nice summary:

Professors from three leading British universities say International Monetary Fund policies favoring international debt repayment over social spending contributed to the Ebola crisis by hampering health care in the three worst-hit West African countries.

...IMF policies contributed to "under-funded, insufficiently staffed, and poorly prepared health systems" in the three countries — a major reason the outbreak spread so rapidly, the report said. The IMF's insistence on decentralized health care made it difficult to mobilize a coordinated response to Ebola, it said.

Their basic argument: the IMF gives lip service to social services, but their insistence on financial austerity starved the health systems of Guinea, Sierra Leone, and Liberia, and the crisis is worse because of it.

Unfortunately, this just doesn't really make sense if you're familiar with the governments in these places, local politics, or more generally how weak states actually work. I see more opinion than evidence. To me, it illustrates of the perils of doing research from afar, and ignoring politics.

First, it assumes the thing that's holding the country back is not enough money for public spending. Places like Liberia and Sierra Leone are actually awash with more outside money than ever before.

More importantly, after decades of war and political instability, the real problem is that they don't have the people or the public organizations capable of spending more money well, even if they want to. We're talking about countries that can't get basic supplies like plastic gloves out of the warehouses by the port and into hospitals. The reason is not too little public money.

If you haven't worked in a weak state, you have no idea how hard it is to get even basic things done. Trying to run research and programs in Liberia nearly broke me. It takes decades for countries to recover from complete state collapse. Liberia and Sierra Leone have only had about 10 years of real stability. In the meantime, a lot of things we take for granted in other countries, even other poor countries, just do not work.

Second, the Lancet comment assumes the government actually wanted to spend more money on health systems. As it happens, these countries have reasonably good and well-intentioned governments. It could be a lot worse.

Even so, the governments have a dozen priorities that come before health systems. Some of them are reasonable ones (like power supplies and roads) and some are not (lining the pockets of supporters). Health was not top of their lists. And health systems in remote areas of the country wasn't even in their imagination.

This is exactly the right choice: When you're three steps removed from war or a coup, and you don't have a functioning police or justice system, building a fine public health system is not your first investment.

Finally, it assumes the IMF had any real influence over health policy and spending. As one senior adviser to the Liberian government wrote Tuesday, "the IMF has about as much influence over health systems building as the Lancet does over central banking."

We so easily default to a Western-centric view, where it's our aid or financial policies that are responsible for the success or failure of poor countries. It's egoistic and exaggerated, and ignores domestic politics.

In my experience, you don't see this as much when people write about India or China or Iraq. Too many people know something about these countries, including newspaper and journal editors. As a writer or researcher, you don't get away with ignoring the context: who makes the decisions, who has what incentives, and what arms of the government can actually get things done.

When it comes to Africa, however, too many people are willing to assume it's a blank slate, and that nations dance to the tune of Western donors and banks. Or that weak states are functioning, rational bureaucracies. I think this is one reason why so many newspapers are picking up the "IMF caused the Ebola crisis" so uncritically.

Ironically, this is exactly the mistake that the IMF made through much of the 1980s and 1990s. Whether you agree with the actual policies or not, the IMF prescribed reforms assuming they were dealing with governments that could and would implement them. And it backfired.

The Lancet piece, and the global health system in general, is making the same mistake today. This more than anything is what worries me about the global response to Ebola.

source: http://www.washingtonpost.com/

The government is tinkering with options in anticipation of looming financial trouble in the national health insurance (JKN) program caused by soaring medical bills submitted to the Healthcare and Social Security Agency (BPJS
Kesehatan).

The state agency, which is managing the insurance, has revealed that its claim ratio reached 99.6 percent in November, while the National Social Security Council (DJSN) expected the December claim ratio to reach 101 percent.

The claim ratio is the difference between the hospitals' bills for health services and the premiums collected by the agency from the various groups of people registered in the program.

The agency receives premiums from tax funds to finance the poor in the scheme, as well as premiums paid by employees and their employers, and those individually registered for the insurance.

As of November, BPJS Kesehatan had paid more than Rp 31 trillion (US$2.47 billion) in hospital claims.

BPJS Kesehatan legal and communication director Purnawarman Basundoro said Thursday that the agency was accepting any input to ease the financial burden caused by the high claim ratio.

"All suggestions will be considered and [the premiums] will be revised in the presidential regulation in 2015," he said.

Purnawarman was referring to Presidential Regulation No. 111/2013 that stipulates the monthly premiums paid for all categories of beneficiary.

The current premium for the poor is Rp 19,500, a far cry from the calculation made by Hasbullah Thabrany, the University of Indonesia (UI) Center for Health Economics and Policy Studies' chairman, who said the monthly JKN premium should be Rp 40,000 per person.

"For the poor, the realistic premium for an adequate health service is Rp 40,000. But if you want the best health service, then it is higher, at Rp 60,000," Hasbullah said Thursday. "Our current spending on health care is only a quarter of Malaysia's."

Purnawarman said the premiums needed to be adjusted to sustain the JKN program.

"The budget management is directed toward a sustainable way for the future, not just sustainable for one or two years. It is our duty to make sure this program can be funded long-term," he said.

The Health Ministry's health care funding center head Donald Pardede said Thursday that the current claim ratio meant BPJS Kesehatan would not be able to sustain its finances in the long run.

"According to the regulation, the maximum claim ratio is 90 percent. Above that is already unhealthy," he said.

Right now, the ministry was doing some calculations on the payment scheme and its premiums, according to Donald.

"Actually we have several options. We had suggested the premiums be set at Rp 22,500, but then the presidential decree would have to be revised," he said.

Another option was to adjust the current healthcare service charges in BPJS Kesehatan's Indonesian Case-Based Group (INA-CBG) to increase participation by private hospitals, which would in turn increase the number of people registered in the JKN program.

Earlier this year, the payment scheme was revised following complaints from private hospitals partaking in the program about unfavorable rates for medical services.

Charges for some 39 services were raised, including ophthalmic services, orthopedic surgery and neo-surgery, while charges for 60 other services were decreased to compensate for the increases.

"From our previous calculations, when we increased the charges for 39 services, we hit a financial barrier. But if the financial platform [from the Finance Ministry] is wider, we will be able to maneuver [around the financial troubles]."

source: http://www.thejakartapost.com

The British government has been urged to press world leaders to review the function and structure of the World Health Organisation (WHO) following its failure to recognise the scale and the severity of the Ebola crisis.

The House of Commons international development committee has criticised the WHO and also the Department for International Development (DfID) for not reacting quickly enough when the virus took hold earlier this year.

But it commended DfID for the "vigorous efforts" now being made in Sierra Leone, where Britain has taken the lead in international aid, mirroring the US role in neighbouring Liberia and France's role in Guinea.

The international development committee warned that the global health system "remains dangerously inadequate for responding to health emergencies" and said "DfID should not wait for its 2015 multilateral aid review" to do something about this, adding: "The urgency of the situation warrants immediate action."

It pressed the international development secretary Justine Greening to move quickly and decisively to guard against a repeat of the disaster, which has claimed the lives of almost 7,000 people in west Africa.

The committee asked DfID to set up a global conference in 2015 to agree a common plan to reconstruct health systems in the region, which it said were already fragile before the outbreak.

"It is imperative that once the immediate crisis is over, the eyes of the world do not turn away from the region," it said.

A DfID spokesman said: "The UK is the largest bilateral donor to Sierra Leone and our action in response to this unprecedented Ebola epidemic is already having a significant impact.

"There are very few health systems in the world that could withstand a health crisis on this scale, but it is right to say we need to learn lessons from how the WHO and the international community responded.

"We will continue to support the people of Sierra Leone, both throughout the immediate emergency and in the recovery period."

Sir Malcolm Bruce, the Liberal Democrat MP who is chairman of the international development committee, said: "Had attention been paid over recent years to strengthening the health system as we recommended in the past, and had more Sierra Leonean health professionals been retained in the domestic system, the impact of Ebola would have been less severe."

The committee commended all those who have risked their lives to tackle Ebola, in particular those working with Médecins sans Frontières.

"[It was] the first international organisation to recognise the scale of the epidemic and respond accordingly. Unfortunately, the World Health Organisation was slow to do likewise. This was a failing on its part. However, it was also a failing on the part of its members, who cut its funding and have put insufficient emphasis on building sustainable health systems in developing countries," its report said.

The committee also criticised DfID for not disbursing funds quickly enough in Sierra Leone. If found that, as of 26 November, only £117m of the £230m pledged had reached Sierra Leone, "falling some way short of disbursement rates achieved by other donors".

The evidence suggested there were still insufficient medical professionals to staff new treatment centres, and the committee asked for monthly updates from DfID on its plans.

It said it was "to some extent not a surprise" that Sierra Leone's health system had been "overwhelmed" by the Ebola outbreak given the continued fragility of its infrastructure since the civil war, which ended in 2002. The country was "woefully short of doctors and nurses before the crisis began" and had difficulty retaining those who had trained in the country.

source: http://www.theguardian.com/

NEW YORK, 12 December 2014 / PRN Africa / — A new global coalition of more than 500 leading health and development organizations worldwide is urging governments to accelerate reforms that ensure everyone, everywhere, can access quality health services without being forced into poverty. The coalition was launched today, on the first-ever Universal Health Coverage Day, to stress the importance of universal access to health services for saving lives, ending extreme poverty, building resilience against the health effects of climate change and ending deadly epidemics such as Ebola.

Universal Health Coverage Day marks the two-year anniversary of a United Nations resolution, unanimously passed on 12 December 2012, which endorsed universal health coverage as a pillar of sustainable development and global security. Despite progress in combatting global killers such as HIV/AIDS and vaccine-preventable diseases such as measles, tetanus and diphtheria, the global gap between those who can access needed health services without fear of financial hardship and those who cannot is widening. Each year, 100 million people fall into poverty because they or a family member becomes seriously ill and they have to pay for care out of their own pockets. Around one billion people worldwide can't even access the health care they need, paving the way for disease outbreaks to become catastrophic epidemics.

"The need for equitable access to quality health care has never been greater, and there is unprecedented demand for universal health coverage around the world," said Michael Myers, Managing Director of The Rockefeller Foundation, which is spearheading Universal Health Coverage Day. "Universal health coverage is an idea whose time has come – because health for all saves lives, strengthens nations and is achievable and affordable for every country."

For much of the 20th century, universal health coverage was limited to a few high-income countries, but in the past two decades, a number of lower- and middle-income countries have successfully embraced reforms to make quality health care universally available. Countries as diverse as Brazil, Ghana, Mexico, Rwanda, Turkey and Thailand have made tremendous progress toward universal health coverage in recent years. Today, the two most populous countries, India and China, are pursuing universal health coverage, and more than 80 countries have asked the World Health Organization for implementation assistance.

"Putting people's health needs ahead of their ability to pay stems poverty and stimulates growth," said Dr. Tim Evans, Senior Director for the Health, Nutrition and Population Global Practice at the World Bank Group. "Universal health coverage is an essential ingredient to end extreme poverty and boost shared prosperity within a generation."

The 500+ organizations participating in the first-ever Universal Health Coverage Day coalition represent a diverse cross-section of global health and development issues, including infectious diseases, maternal and child health, non-communicable diseases and palliative care. Across these issues, knowledge and technologies exist to save and improve lives in significant numbers, but the impact of these tools is severely hampered by lack of equitable access to quality health services.

"Ebola is only the most recent example of why universal health coverage is the most powerful concept in public health," said Dr. Marie-Paule Kieny, Assistant Director-General for Health Systems and Innovation at the World Health Organization. "Investing in strong, equitable health systems is the only way to truly protect and improve lives, particularly in the face of emerging threats like the global rise of non-communicable diseases and increasingly severe natural disasters."

Events in 25 Countries Mark First-Ever Universal Health Coverage Day
Organizations around the world are calling on policymakers to prioritize universal health coverage, and are hosting events on 12 December to catalyze action, including:
New York, USA: High-level event on Ebola and resilience, organized by the Permanent Missions of France, Japan, Germany and Senegal to the United Nations, in collaboration with The Rockefeller Foundation and the Columbia University Mailman School of Public Health.
London, UK: Expert panel at the London School of Hygiene & Tropical Medicine on creating resilient, equitable health systems, organized in partnership with The Rockefeller Foundation and Action for Global Health.

New Delhi, India: High-level event on universal health coverage implementation in both India and the global context, convened by the Public Health Foundation of India, Oxfam India and the World Health Organization Country Office for India.
SOURCE World Health Organization (WHO)

http://en.starafrica.com/

In the United States, there can be no question as to whether or not Obamacare is controversial. It's been the subject of so much gridlock and partisanship at this point that no matter how it's reformed or changed or improved, there will likely be some that hate it. The push back against Obama's Affordable Care Act has, predictably, garnered some attention from other countries, and there's been a great deal of talk about how other nations feel about Obamacare and their impressions of how Americans have reacted to it.

In particular, criticism from our closest neighbor, Canada, has been interesting to watch. Salon offers just one sample of Canadian health care discourse when pitted against a member of the GOP, quoting Dr. Danielle Martin from Women's College Hospital in Toronto and her opponent, Sen. Richard Burr (R-N.C.). Martin also admits downfalls of Canadian public health and where the solution may lie. "The solution to the wait-time challenge that we have in Canada ... does not lie in moving away from our single-payer system to a multi-payer system," she said, pointing to Australia as an example.

I point this out, not in support or opposition of either system, but rather because this admission of problems alongside praising the aspects that work is what I'd like to focus on. Because indeed, every health care system around the world has its pros and cons; even ones with clear advantages over America's past and present system have faults, and it's useful to consider what they are. So rather than rehash what is at this point a very tired argument over health care reform and the Affordable Care Act, I'd like to look internationally.

Canada
First, let's start with Canada; it seems an appropriate first stop on our list given the above context. Canada has universal health care and has government sponsored health care for all citizens. Each of the 13 provinces has some degree of power, but must meet national standards in order to be eligible for funding. Perhaps the most notable and obvious advantage to Canada's health care is that it is so universally available and affordable. And the most obvious disadvantage, at least based on the majority of rhetoric discussing Canadian health care, has to do with extreme wait times — consider our VA scandal earlier this year and what wait times can mean for patients.

Going back to Martin and Burr's discussion, Martin basically pitted these two items against each other, when asked how many patients die while waiting to be treated. "I don't [know], sir, but I know that there are 45,000 in America who die waiting because they don't have insurance at all," she said, "we believe that when you try to address wait times, you should do it in a way that benefits everyone, not just people who can afford to pay."

The United Kingdom
According to a health care ranking report from the Commonwealth Fund, the United Kingdom has itself a place on the top of the list for having the best health care out of 11 studied and ranked — with the U.S. falling last on the list. The U.K., on the other hand, ranked very well on a number of criteria. In particular, it did well in terms of the quality of its care and the access people had to the care based on cost. Like Canada, timeliness of care was listed as a bit of a problem, but nothing compared to our neighbor to the north, which was ranked last for timeliness, while the U.K. managed a third place ranking. However, the absolute worst score it received was actually near dead last, in terms of how healthy civilians lives were. Indicators for this were "mortality amenable to medical care, infant mortality, and healthy life expectancy at age 60." Another critique offered has been that the National Health Service caters to immigrants and visitors in the country as well as citizens, and that this complicates costs and wait times.

France
The World Health Organization places France at the top of a list of the World Health Systems — and notes that neither Canada or the U.S. even makes the top 25. France, like Canada, has universal health coverage. It has both private (mutuelle) and public aspects to its system, with a great deal of the cost covered by the government, making medical care much more available and much more affordable in France than in the U.S. Costs are also much more predictable in France than in the U.S.

According to Slate, 53% of France's Gross Domestic Product is funneled to public spending. The wait times in France are considerable, as with Canada, and constitute a serious problem. Cost coverage in France has its advantages and its disadvantages. Some things are very well covered, but certain aspects of treatment and coverage can get pricey depending on your needs. Pharmaceutical expenditure per capita, for example, is much higher in the U.S. — $983 per capita in 2010, according to the Huffington Post — but it's still comparably quite high in France as well, at $634 per capita.

source: http://wallstcheatsheet.com/

about 1 in 13 Americans was suffering from depression at some point between 2009 and 2012, yet only 35% of people with severe depression and 20% of those with moderate depression said they had sought help from a mental health professional, according to a new report from the U.S. Centers for Disease Control and Prevention.

That's troubling, the report authors write, because therapy combined with medication is "the most effective treatment for depression, especially for severe depression." Drugs might be prescribed by a primary care doctor, but only a mental health specialist would conduct the type of therapy needed to get well.

The report, from the CDC's National Center for Health Statistics, offers a snapshot of the nation's mental state during recent years.

The findings are based on interviews with a nationally representative group of American adults and teenagers who participated in the federal government's ongoing National Health and Nutrition Examination Survey. These volunteers answered a range of questions that assessed a variety of physical, cognitive and mood symptoms that are related to depression. Responses from people 12 years old and older were used to compile the report.

Overall, 2.9% of the participants had suffered "severe depressive symptoms" in the two weeks before they were interviewed, and another 4.7% had "moderate depressive symptoms," the researchers found. Americans in their 40s and 50s were the most likely to be depressed, with 9.8% having moderate or severe depression. They were followed by Americans between the ages of 18 and 39, with a 7.4% depression rate. The oldest (ages 60 and over) and the youngest (ages 12 to 17) people in the survey were the least likely to be depressed, with rates of 5.4% and 5.7% respectively.

African Americans (9.7%) and Latinos (9.4%) had higher rates of moderate and severe depression than whites (6.9%), according to the report. (No data were reported for Asian Americans.) However, after the researchers adjusted their findings to take poverty status into account, there were no significant differences based on race or ethnicity.

Gender, on the other hand, had a large effect, with women experiencing higher levels of depression than men in all age groups. The biggest gap was among people in their 40s and 50s -- 12.3% of women in this age group were moderately or severely depressed, compared with 7.2% of men. That 5.1-point difference was 30% bigger than the 3.9-point difference for the entire study population. Overall, 9.5% of women were depressed, along with 5.6% of men.

Depression took a meaningful toll on people's lives, the researchers discovered. About 43% of those with severe depression said they had "serious difficulty" managing their work, home and social activities, and another 45% had "some difficulty." For people with moderate depression, the corresponding figures were 16% and 58%. Even for people with mild depressive symptoms, 4% had serious difficulty with their daily activities and 42% had some difficulty.

Despite these problems, only 35% of people suffering severe depression and 20% of those with moderate depression told interviewers they had seen a mental health specialist, such as a psychologist, psychiatrist, psychiatric nurse or clinical social worker. (The researchers couldn't verify whether these people actually began treatment for their depression.) Latinos were the least likely group to seek professional help from a mental health specialist -- only 28% of those with severe depression and 17% of those with moderate depression did so, according to the report.

source: http://www.latimes.com/

Community groups in the Asia-Pacific are taking the lead on prevention initiatives for cancer, diabetes, heart disease and other non-communicable diseases which cause 36 million deaths globally. This APEC project helps counter the rise of these diseases by conducting outreach and education on the risk factors and preventive lifestyle changes at the local community level. Following a successful trial across Indonesia, the project developed a framework and guidebook for other APEC economies to replicate this grassroots approach over the next few years.

Led by the APEC Health Working Group, the project comes as the incidence of death through non-communicable diseases such as cancer, diabetes and heart disease continues to rise, especially in the Asia-Pacific region. According to the World Health Organisation (WHO), deaths from these diseases in Southeast Asia alone will grow by 15 per cent over the next decade, reaching 10.4 million per year by 2020. In many cases, these diseases are detected at a later stage, resulting in higher economic cost for treatment.

"Non-communicable diseases are now the leading cause of death in many APEC economies," says Dr Ekowati Rahajeng, Director of Non-communicable Diseases at the Indonesian Ministry of Health, who leads the project. "Cardiovascular disease accounts for about one-third of all deaths in Asia, with mortality rates, on average, 70 per cent higher than in OECD countries. Cancer alone causes an estimated 13 per cent of deaths in Asian economies."

According to Dr Ekowati, raising awareness of the risk factors associated with these diseases—such as obesity, lack of exercise and smoking—is the most effective way to overcome the fatalities. "Our community-based approach has huge potential, because it teaches people how to protect themselves," she says. "Without action, non-communicable diseases could have a catastrophic impact on health budgets."

Community-based intervention: a different approach

The successful model for community-based intervention began in Indonesia over a decade ago, with a single pilot study. It involved experienced, local health workers partnering with community leaders to explain the risk factors that contribute to diabetes, cancer and heart disease, clearly and directly to groups of citizens.

"What makes this approach different is that activities take place in community areas such as schools or religious centres, rather than clinics," says Dr Ekowati. "Also, activities are driven by local community members, who know how to stimulate attendance and participation."

The initial pilot was soon replicated in four other provinces in Indonesia. The Community Co-ordinator for West Jakarta, Ms Joko, explains how the program works: "I am one of a group of eight friends, which includes a senior nurse, and through the community-based intervention project, we received training in non-communicable diseases at local health centres."

Each month, Ms. Joko organises a consultation for between 50 and 70 people, which is supervised by a public health service official. A local doctor measures each individual's vital signs as well as weight, and then tests blood sugar, and levels of cholesterol and uric acid.

"The sessions allows us to do three things: clearly explain the risks factors that contribute to cancer, diabetes and heart disease, assist with early detection, and then observe changes in behaviour over time," she says.

Proven results, and expansion across Indonesia

The community approach enabled Dr. Ekowati's project to closely monitor its effectiveness, and the results proved impressive. Between 2003 and 2006, the prevalence of high cholesterol among target groups in one district—Depok, West Jakarta—reduced by a third, from 31.65 per cent to 19.6 per cent; the prevalence of high blood pressure halved, from 9 per cent to 4.5 per cent, and mean body mass index (BMI) measurements fell for both men and women.

With clear evidence that the project's unique community-based intervention approach had a concrete impact, the project gained acclaim. In 2012, the community-based model for non-communicable disease reduction was formally incorporated in Indonesia's health strategy. Community programs were implemented in all 34 provinces in Indonesia, with approximately 11,000 community groups delivering risk-factor programs in each of 500 local districts.

Gaining traction across the APEC region

In 2013, the APEC Health Working Group funded the project to expand the approach in the region— recognising that Indonesia's model could help member economies take practical steps to respond to two key international health initiatives: the WHO Global Action Plan on non-communicable diseases 2013–2020, and the 2011 declaration on non-communicable diseases by the United Nations General Assembly.

Dr Ekowati proposed using the Indonesian community-based intervention experience to design and develop a comprehensive community program that could be used by multiple economies—right across the Asia-Pacific region. It would include guidelines for community health discussions, and a framework to help community workers set up each local project.

With funding from the APEC Support Fund, Dr Ekowati convened a landmark workshop in April 2014 in Bali, Indonesia. The prospect of adopting a tried and tested strategy for non-communicable diseases prevention drew health experts, academics, and policy makers from Chile, Japan, Malaysia, Peru, the Philippines, Russia, South Korea, Thailand and the USA.

Input from these specialists resulted in an APEC guidebook for implementing the approach in other economies which was published in August 2014. The framework on community-based intervention explains how the concept works in practice, examines the challenges involved and provides recommendations to help APEC economies learn from Indonesia's experience.

APEC member economies such as the Philippines and Thailand now intend to use this guidebook to help implement community-based prevention programs of their own.

The bigger economic picture

As the program readies for APEC-wide rollout, its sponsor is quick to point out that the goal of containing and reducing these non-communicable diseases is inseparable from wider social and economic objectives.

"Cancer, diabetes, heart disease and other non-communicable disease are chronic illnesses that require long-term treatment," Dr Ekowati says. "The costs of treatment and healthcare lead to higher health expenditure and lower productivity—and remember these diseases are the biggest cause of premature death."

According to the World Health Organization, non-communicable diseases cause an estimated 63 per cent of global fatalities every year.

"Without these social programs, there will be an inevitable decline in the economic status of many people—in particular those on middle or low incomes. This program has huge potential, not just to limit the impact these diseases have on prosperity today, but to prevent non-communicable diseases from dominating health budgets in the future."

source: http://www.webwire.com/