The WHO's South-East Asia regional countries have much to learn from Bangladesh, the UN agency's chief Margaret Chan has said.

She praised Bangladesh's overall health achievements and described its health leadership as "inspiring" that could serve as a lesson for other countries of the region.

The Dictor-General was speaking at the inauguration of the WHO SEARO's meeting, which began in Dhaka on Tuesday.

Prime Minister Sheikh Hasina inaugurated the gathering that drew ministers of eleven countries.

Chan said Bangladesh's "stunning rise" in the overall health status and life expectancy had been internationally documented.

And it overcame many challenges the country had faced, she said.

Despite many challenges Bangladesh had faced over decades, "the solid improvements in the country's health system and the services it provides, together with a stunning rise in overall health status and life expectancy have been internationally documented".

"The countries of the Region have much to learn from the rich experience and inspiring health leadership of Bangladesh."

Bangladesh, Bhutan, North Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste are the members of WHO's South-East Asia Region.

Opening the meetings, Prime Minister Hasina made a personal plea to the health delegates from the countries to support Bangladesh's efforts to mobilize global support for the cause of autism.

"It is imperative that individuals with autism and other developmental disabilities must find easy access to improved diagnosis and services," she said as Bangladesh was pursuing "universal health coverage" for all.

source http://bdnews24.com

Ooredoo and the Leo Messi Foundation have officially launched mobile health clinics in Indonesia.
The ceremony took place in Jogja, the capital of the Yogyakarta Special Region in Java, which marked the first step in an on-going expansion of Ooredoo's and the Leo Messi Foundation's healthcare initiative announced in May. Plans are in place to make more clinics accessible in Indonesia, Myanmar, Algeria, and Tunisia as part of the programme.

With a focus on the importance of education and healthy living for communities, the clinics will play an informative role, in addition to providing people with a range of free services, including medical checks, dental checks, nutritional advice and vitamin distribution.
The launch ceremony was attended by Sheikh Abdullah bin Mohamed bin Saud al-Thani, Ooredoo chairman and chairman of the board of commissioners of Ooredoo's company in Indonesia, Indosat; Dr Nasser Marafih, Group CEO, Ooredoo; Alexander Rusli, president director and CEO, Indosat; and representatives of Jogja's local government.

In addition, 150 parents and 150 children attended the event, where they received messages about the prevention and cure for common illnesses, as well as the importance of a healthy lifestyle and education for the children.

Dr Marafih said: "These mobile health clinics are an investment in the future of the communities we serve."
He added: "I had the opportunity to see the mobile clinics in action. They travel out to remote areas, staffed by medical professionals and volunteers, and actively work with the community to address a range of healthcare issues...we are passionate about helping them to reach as many people as possible, not only here in Indonesia but across all of the markets that we operate in."

Alexander Rusli, president director and CEO, Indosat, said:
"The mobile clinic programme was created as an immediate response to some of the serious health issues facing people in Indonesia's rural and under-served communities. To date our clinics have treated 600,000 people in Indonesia."
The Ooredoo mobile health clinic initiative was launched in 2013 in partnership with the Leo Messi Foundation. As part of this partnership, the two organisations are providing healthcare in rural areas across Ooredoo's footprint in South East Asia, the Middle East and North Africa, aiming to reach more than 2mn young people with services by 2016. Ooredoo also works with football hero Leo Messi as its global brand ambassador.

source http://www.gulf-times.com

As medical researchers struggle to produce desperately needed drugs to fight the Ebola outbreak, the World Health Organization on Friday endorsed an old-school remedy that is already abundant in Africa - the blood of people who have survived infection.

Health officials acknowledged that their support for blood transfusions was motivated by emotion as well as by science. Limited quantities of a tested vaccine will not be available until November at the earliest, and stocks of experimental drugs such as ZMapp may not be ready until next year.

"One of the things driving fear and panic in communities ... is the belief that there is no treatment for Ebola virus disease," said Marie-Paule Kieny, an assistant director-general at the United Nations' health agency. "We have to change the sense that there is no hope."

But to others, the move looked more like an act of desperation than a decision based on clinical evidence.
"It's an unproven therapy," said Dr. William Schaffner, an infectious disease specialist and professor at Vanderbilt University in Nashville. "It ought to be evaluated critically before we start investing huge amounts of money."

The concept behind the transfusions is simple: The blood plasma of people who have recovered from Ebola contains antibodies that were successful in fighting off the virus. If these antibodies are pumped into an infected person, they might help the recipient fight the disease as well.

Such transfusions were used to fight illnesses before the advent of antibiotics and vaccines. The German surgeon Emil von Behring first used blood serum to treat diphtheria in 1890 and was awarded a Nobel Prize for his discovery. The technique was expanded to treat many other infectious diseases, such as scarlet fever and measles, before it fell out of favor.

Its effectiveness in fighting the Ebola virus is a matter of debate.

Transfusions were used to treat a small number of patients during the 1995 Kikwit Ebola outbreak in Zaire, now known as the Democratic Republic of Congo, according to Dr. Oyewale Tomori, a professor of virology at Redeemer's University in Nigeria. A study published in the Journal of Infectious Diseases after the outbreak reported that eight patients received transfusions, and only one died.

"The reason for this low fatality rate remains to be explained," the researchers wrote. The blood transfusions may not have been responsible for their recovery, they noted: "The transfused patients did receive better care than those in the initial phase of the epidemic."
Transfusion techniques have improved since then, Tomori said. The method has already been used in the current outbreak, which began in March and has sickened at least 3,967 people and killed at least 2,105, according to the World Health Organization.

Dr. Kent Brantly, an American aid worker who was infected with Ebola in Liberia, was given blood serum from a boy who survived an Ebola infection. He and fellow aid worker Nancy Writebol also received the drug ZMapp. The two were evacuated to Emory University Hospital in Atlanta, where they both made a full recovery.

Ebola is spread by contact with the bodily fluids of infected individuals. Once in the bloodstream, the virus enters cells and begins to replicate itself, damaging blood vessels and organs in the process. Symptoms begin to appear two to 21 days after infection and include fever, diarrhea, vomiting, aches and bleeding. In the current outbreak, the odds of survival are slightly below 50 percent.

Kieny said the use of blood transfusions was the topic of intense discussions last week during a WHO-sponsored conference of more than 200 health and pharmaceutical experts. They were meeting in Geneva to weigh the deployment of up to 10 Ebola drugs that are now under development, including two experimental vaccines.

"There was a consensus that this has a good chance to work, but also that this is something that can be produced now from the affected countries themselves," Kieny said.

That doesn't mean transfusions can begin immediately, she added. The international community needs to help hard-hit West African nations including Guinea, Sierra Leone and Liberia build the capacity to safely draw blood, type it to make sure donors and recipients are compatible, remove the red blood cells from the antibody-containing serum, store the serum properly and then deliver it to patients using proper equipment. Blood should also be screened to make sure the transfusions would not spread other diseases, such as HIV.

"All efforts must be invested into helping affected countries," Kieny said. "This should be done as a priority . so that this procedure can be put at play as soon as possible."

source: http://www.fayobserver.com

The world's leading public health voices are all in agreement that West Africa is losing precious time in the fight against its ongoing Ebola outbreak, and the window is closing on containing the virus in the region.

"The level of outbreak is beyond anything we've seen—or even imagined," Director of the Centers for Disease Control and Prevention Thomas Frieden said at a press conference this week as he returned from a visit to the affected areas-- mostly the nations of Guinea, Sierra Leone, and Liberia, though Senegal and Nigeria have both reported instances of Ebola infections. Frieden lamented that "the window is closing" on preventing the outbreak from becoming a full epidemic, and the nations on the front lines severely lack the resources to contain the virus.

To the editor:
The outbreak of the Ebola virus in the West African nations of Guinea, Liberia, Sierra Leone, and Nigeria has brought into sharp focus the importance of the United Nations global health affiliate the World Health Organization (WHO). With respect to matters of global health, no other organization is capable of mobilizing the resources, responding to, and combatting threats to public health. It is a vital actor on the world stage as it must confront some of the deadliest diseases known to man.

The WHO is guided by six main roles as stipulated by the organization's Eleventh General Programme of Work 2006-2015. The roles are:

1. Providing leadership on matters critical to health and engaging in partnerships where joint action is needed;
2. Shaping the research agenda and stimulating the generation, translation and dissemination of valuable knowledge;
3. Setting norms and standards and promoting and monitoring their implementation;
4. Articulating ethical and evidence-based policy options;
5. Providing technical support, catalyzing change, and building sustainable institutional capacity;
6. Monitoring the health situation and addressing health trends.

Precision Response is Key

How WHO responds to public health threats, such as disease outbreaks or natural disasters, requires a precise and coordinated plan. The disproportionate share of the affected people WHO serves reside in the developing world. They are the poorest and most vulnerable individuals. Any delay in responding to their needs can mean the difference between life and death, particularly as it relates to a virus like Ebola. As a result, WHO set forth a "roadmap" this past week to put an end to any further transmission of Ebola in the next 6-9 months. In addition the global health body plans to minimize its spread, while also focusing on the larger societal and economic consequences as a result of the outbreak. WHO knows time is of the essence, and there is no entity better equipped to handle this crisis than them.

No End in Sight

According to Margaret Chan, director-general of WHO, writing in the New England Journal of Medicine, "No one is talking about an early end to the outbreak." She added that she anticipates Ebola continuing for "many more months." There is one issue that the director-general believes has exacerbated the problem – poverty. These West African nations of Guinea, Sierra Leone, and Liberia rank well below the poverty line. These countries have had to endure years of conflict and civil war that has decimated their ability to combat this virus. The health infrastructure is essentially non-existent; it is estimated that there are one or two doctors per 100,000 people in West Africa, according to Dr. Chan.
Poverty forces individuals to flee their homeland in search of work. This migration causes a spread of the virus that threatens areas not previously inflicted. Liberia recently closed many of its borders to prevent such an occurrence from happening. However, this is not something that is easily accomplished. As the death toll continues to mount, the challenges for the health professionals on the ground becomes greater every day.

U.N. Broadens Its Efforts

In an effort to assist in stemming the tide of the Ebola virus, U.N. Secretary-General Ban Ki-moon last week appointed Dr. David Nabarro as Senior U.N. System Coordinator in charge of Ebola. Dr. Nabarro will work closely with Dr. Chan of WHO in coordinating their efforts. Dr. Nabarro, in an interview with UN News Centre, indicated that WHO's primary responsibility is to diagnose and treat those who may be infected. This is a massive undertaking and an important reason why we need WHO. In his interview, Dr. Nabarro noted that when he met with the leadership of the various nations affected by Ebola he noted that they said to him they wanted WHO to take the lead to assist them in treating their respective citizens. In order to properly inform the public and to avoid widespread panic, the health professional remarked that social media has a crucial role to play in getting the right message out to people. If the public receives incorrect information, this will only complicate an already dangerous situation.

Unmatched Success

The accomplishments of WHO in the area of global health is unrivaled. The most notable achievement came in 1950 when the eradication of smallpox was realized. As a result, life expectancy in the developing world has seen a 60% rise. Furthermore, according to the Center for Global Development, children under the age of five now have a greater chance of survival. WHO has largely been responsible for controlling tuberculosis in China; eliminating childhood polio in Latin America; many regions on the continent of Africa have experienced the containment of river blindness; and Sri Lankan women do not fear dying during childbirth all as a result of the efforts of WHO.

Should the U.S. be worried?

We have all seen the images of the doctor and aid worker be transported back to the U.S. from the region after contracting Ebola. Thankfully they both appear to be doing well at this point and time. However in an era of globalization where people, goods, and services move about so freely, how can one say we will ever be truly free from these epidemics? No one can, but what is known is that there are many dedicated professionals from WHO giving their very best each day in an attempt to manage this crisis. They are essential players in bringing this matter under control. There will always be naysayers who will try to dispute why we need the U.N., or WHO for that matter; but to all those opposed to the U.N. and its agencies think about this question for a moment: If you were ever to find yourself in a country where you were threatened by such a crisis, would you not want the assistance of a global health organization like WHO to assist you? Of course you would! For you to say otherwise would simply be foolish. There is no disputing the fact that their work is crucial to the survivability of many around the world today.

MICHAEL CURTIN
Editorial Chair and Blogger
United Nations Association of the USA (UNAUSA-NNJ)
unausannj.com

source http://www.nj.com/

President-elect Joko "Jokowi" Widodo may rename the existing national health insurance (JKN) program the Healthy Indonesia Card (KIS) program, as both health programs share a similar purpose, observers have said.

Hasbullah Thabrany, professor at the University of Indonesia's School of Public Health, said that if the KIS, a free health-care program promoted by Jokowi during his presidential campaign, were to stand on its own, it would require new legislation that would consume too much time and resources.

If Jokowi decides to continue or expand the current nationwide JKN program, which is run by the Social Security Management Agency (BPJS), it would save time and it would be faster in reaching those people who are still waiting for better quality health care.

"Replacing the [JKN] cards with KIS cards is a very practical thing to do, by allowing the new president to focus on improving the program's quality," Hasbullah said during a discussion on the two health programs on Tuesday.

During the presidential campaign, Jokowi said he would implement the KIS as a national program.

Few details about the program have been made available but many consider it to be similar to the Healthy Jakarta Card (KJS) program, which Jokowi implemented in the capital during his two years as governor.

The KJS essentially expanded existing health-care programs, namely Gakin and SKTM, with the Jakarta administration issuing cards and providing health care, not only to those people who were considered poor, but to anyone with a Jakarta identity card who applied to join the program.

Hasbullah said that expanding the JKN would require more work, including a possible revision of the current framework for the insurance, and the BPJS as its provider.

"For example, the new government should be aware that only marginalized people are entitled to free health coverage under the JKN program. Even if it is good, if everyone ends up being covered, that would contravene our regulation," he said.

Article 14 of the National Social Security System (SJSN) Law stipulates that the government is obligated to pay premiums for medical treatment for impoverished people.

The health coverage for the poor, once known as Jamkesmas, is one of the programs currently provided by the BPJS.

The non-profit body also manages health insurance offered by PT Askes (a former entity that became the BPJS), PT Jamsostek and PT Asabri.

Based on BPJS data, as of Aug. 8, the program covered 126.4 million people in total and cooperated with 1,551 hospitals nationwide. The program aims to cover the entire Indonesian population by 2019.

Rieke Diah Pitaloka, a member of the House of Representatives' Commission IX overseeing health and manpower, emphasized that KIS was initiated as a refinement to the BPJS' national health insurance program.

Rieke, who is also a politician with the Indonesian Democratic Party of Struggle (PDI-P), said the current JKN program had yet to reach many marginalized people.

"We even see in the news that sometimes people are rejected treatment by hospitals due to financial issues," she said.

Hasto Kristiyanto, deputy head of Jokowi's transition team, said they were optimistic that the KIS would be approved by House lawmakers.

source http://www.thejakartapost.com

When Indonesian president-elect Joko Widodo takes power in October, he will be confronted by a laundry list of pressing issues, ranging from budget-sapping energy subsidies and urgently needed infrastructure projects to figuring out why heavy spending on education does not seem to be paying off.

Then, there is health. After making steady progress through the 1990s in lowering the country's infant mortality rate, Indonesia has stagnated and will probably fail to meet next year's Millennium Development Goal (MDG) of 28 deaths per 1,000 live births.

According to the United Nations Children's Fund (Unicef), a child below the age of five dies somewhere in Indonesia every three minutes. That is about 150,000 a year, with many of those deaths due to a lack of simple sanitation and hygiene.

Every hour, a mother dies because of complications related to pregnancy or during child birth.

More bad news, this time on the HIV front. Bucking a worldwide downward trend in deaths related to acquired immune deficiency syndrome (Aids), a new United Nations report says Indonesia is one of six countries being left behind, with a massive 427 per cent increase in cases between 2005 and 2013.

Tuberculosis (TB) is another priority. With 91,000 deaths among the 528,000 cases of the disease recorded each year, Indonesia has the third highest TB rate in the world, behind China and India.

That is a troubling 6.3 per cent of total recorded diseases, compared with 3.2 per cent across the rest of the South-east Asian region.

Poor health-care system

Healthy economic growth is supposed to bring equivalent dividends in the quality of health care. Yet despite this year's promising roll-out of Universal Health Care (UHC) for 86.4 million of the nation's poor, the 1 per cent of GDP invested in health remains one of the lowest in the world.

That leaves it on a par with neighbouring countries like Laos, Cambodia and the Philippines, but behind Malaysia and Brunei on 2 per cent, and Vietnam and Thailand, both on 3 per cent.

Neo-natal deaths - when a baby dies within 28 days of birth - point to flaws in the efficient and effective delivery of quality round-the-clock mid-wifery and referral services, which in turn are often related to larger health system issues.

Infant deaths may have been reduced from 97 to 31 (per 1,000 live births) since 1990, but the rate has plateaued now that the large-scale introduction of immunisation, vitamin A distribution and what health professionals call other so-called "low-hanging" fruit has run its course.

Of course, there are much bigger geographic and demographic challenges for a sprawling archipelago of 250 million people, but, all the same, compare that 31 figure to the Philippines (30), Vietnam (23), Thailand (13) and Malaysia (nine).

But even today, in a country where a surprising number of urban dwellers prefer going to a traditional healer rather than a real doctor, Indonesia has the third highest number of non-immunised children. As a result, it still experiences outbreaks of vaccine-preventable diseases like measles and diphtheria.

While president Susilo Bambang Yudhoyono's government may have increased access to health services over the past decade, better-quality advice is needed when it comes to such things as swaddling and longer-term breast-feeding.

Malnutrition and poor water and sanitation are major contributors to child mortality. It is sobering to read that Indonesia has the fifth highest number of stunted children in the world and the second highest number of people - 52 million - practising open defecation.

Frustratingly, increasing coverage on interventions is not translating into reduced mortality. The same lack of progress applies in a different way to education, despite the fact that public spending absorbs 3 per cent of GDP.

Outer Islands

While rates of mortality soar in less populated parts of Indonesia, it is the high population pockets that contribute to the greatest numbers in terms of morbidity and deaths. Health experts say both require radically different approaches.

Isolated groups of small islands and parts of Papua require more "waiting homes" so expectant mothers have somewhere to go to await birth. It has taken time to explain to husbands why this is necessary, particularly in Papua where under-five mortality rates stand at 90 per 1,000 live births.

In many parts of less-developed eastern Indonesia which, along with Kalimantan, accounts for 15 per cent of the total population, a 24/7 service just is not there. There may be health clinics dating back to president Suharto's days, but they often do not have proper facilities or even basic medicines.

The reason seems obvious. Decentralisation may have been politically crucial when it was launched in 2001, but it has also blurred the lines of authority and impacted negatively on accountability.

The lack of a regular mechanism to track progress masks serious regional inequalities. What is needed is a systems approach to health service delivery, such as the better distribution of skilled health-care providers and the identification of bottlenecks.

The challenge of HIV

Indonesia's HIV epidemic is a related threat. About 10 people die of Aids-related illnesses every day. Six years ago, an estimated 200,000 children and young people under 25 were living with HIV. Today, they are now believed to be responsible for a fifth of new cases, or at least seven a day.

Along with the Central African Republic, the Democratic Republic of the Congo, Nigeria, Russia and South Sudan, Indonesia faces the triple threat of a high HIV burden, low treatment coverage and little if any decline in new HIV infections.

Experts attribute the increase to the high number of people from traditionally low-risk population groups contracting HIV and to the government's failure to ensure access to anti-retroviral therapy for those already living with the disease.

About 3 per cent of those infected with HIV also have active tuberculosis. This prevents people from earning wages and leads many already-poor families ever deeper into poverty because of the high cost of sustained treatment.

Mostly, the disease preys on those living in rural areas, those with weak immune systems and those seeking health services from centres that do not treat the disease in the directly-observed, low-cost way recommended by the World Health Organisation.

Joko has some major challenges ahead. But given the huge toll that preventable and curable disease is taking on the nation's children, it is hoped health will become as much a priority as education.

source http://www.thejakartapost.com

Indonesia's conditional cash transfer program, Program Keluarga Harapan (PKH), provides cash to poor households in exchange for meeting specified health targets. It aims to reduce poverty and improve maternal and child health. But does it work?

After the success of Mexico's social assistance program PROGRESA (now Oportunidades), Indonesia followed suit in 2007 with the implementation of a pilot program, PKH. PKH set out to speed up the attainment of the Millennium Development Goals, especially poverty reduction and improved maternal and child health. Indonesia's PKH targets the poorest households with children or expectant mothers. The requirements typically include prenatal and postnatal checks, vaccinations and school enrolment and attendance.

Under PKH, program participants are required to have four prenatal visits; facility-based delivery (the original requirement was childbirth assisted by a trained health care provider); two postnatal visits; monthly weighing; vaccinations and vitamin A for children under five; and enrolment in primary and junior high school with a minimum of 85 per cent attendance for school-aged children.

To the government's credit, PKH has been more successful than other social assistance programs in identifying and enrolling poor households. The impact evaluation finds that the program has increased participants' utilisation of primary health care services, which suggests that the program has improved health care access for the poor. Unfortunately, the program has no effect on education. This is not surprising, however, since primary school enrolment is already high (greater than 80 per cent) and the transition rate to junior high school is fairly high (roughly 75 per cent).

Even though the program is successful in getting participants to 'show up' to meet the health requirements, participants' health-seeking behaviour unfortunately has not translated to improvements in long-term outcomes — such as reductions in the incidence of low birth weight and mortality. The lack of impact here is partly related to the supply side of the health care market.

Conditional cash transfer (CCT) programs operate best when the health care system has adequate supply to absorb the additional demand stemming from the program requirements. In some places, there is insufficient supply or no excess capacity in the health care system, so there is a change in price, quantity or quality from the supply side — which can dampen the effects of the program. In particular, higher prices are expected in the short term, before new health care providers can enter the market to increase supply. This increase in demand may also reduce quality of care as providers see more patients.

Indonesia's public providers are also allowed to hold private practice part-time, and this potentially impacts on the program. As the CCT increases demand for health care — for providers with both public and private practices — they can respond with higher prices in private practice, thereby increasing average prices.

Also, public providers may opt to pursue their more lucrative private practice. This could strain the public system and quality of care would suffer. The combination of lower quality and higher prices could limit health care access, thereby defeating the purpose of the program. This possibility is a particular concern for households that just miss the CCT cut-off.

PKH is planned to go national this year. It will be interesting to analyse the long-term effects and how the effects change as the program expands. The supply of health care will become an even more important issue with the implementation of the national health insurance system, Jaminan Kesehatan Nasional.

The Indonesian government is continuing to seek better ways of delivering health care services to the public and to the poor. As the government is taking steps to strengthen the health care system — through efforts such as PKH — we can be cautiously optimistic for what the future holds.

source: http://www.eastasiaforum.org