The provincial administration has been working hard to properly integrate its Bali Mandara healthcare program (JKBM) into the national health insurance (JKN), which should start early next year.

Ketut Suarjaya, head of Bali Health Agency, said the provincial government was still calculating the allocation for premium subsidies.

Under the JKBM scheme, the provincial government pays Rp 8,500 (72 US cents) per person per month for eligible residents with Bali ID cards. Meanwhile, under JKN, which is managed by the Social Security Management Agency (BPJS), the premium for registered members is set at Rp 23,000 per month. "We have not decided how to integrate JKBM and JKN and what kind of schemes we would like to apply next year, in 2015," Suarjaya said.

JKBM, Suarjaya said, remained valid for residents of Bali who did not possess other health insurance.

A serious consideration and hurdle for the administration is the budget allocation.

The provincial government has allocated Rp 280.6 billion to cover insurance premiums for around 2.75 million people eligible for JKBM in 2013.

"When JKBM and JKN are integrated, we will have to pay more, at least Rp 760 billion per year," said Suarjaya.

Another challenge for the merger of JKN and JKBM is limited hospital space for patients treated in third-class rooms.

"Once we integrate with JKN, we have to provide healthcare services to all Indonesian citizens," he said.

At the same time, the majority of Balinese residents still prefer to use their JKBM facilities.

Previously, the Denpasar Indonesian Doctors Association (IDI) had said JKN would improve healthcare facilities for residents as it could reduce medicine costs. JKN would also shift the present paradigm of healthcare providers.

I Nyoman Mangku Karmaya, professor of medicine at Udayana University and former IDI member, said healthcare services in Indonesia were very confusing, and there was uneven distribution of general practitioners and specialists across Indonesia.

Under the JKN scheme, healthcare services at community health centers (puskesmas) are set at Rp 3,000 to Rp 6,000 per person and Rp 100,000 for in patients. Clinics and hospitals are required to pay the extra medical costs.

Patients can make use of JKN services for every class of health care, depending on the monthly premium paid.

Civil servants and members of the Indonesian Army and Police are required to pay premiums at 2 percent of their salaries, while the government will provide a 3 percent subsidy.

Employees in the private sector have only to pay 1 percent of their salaries, while their employers will pay the remaining 4 percent for the JKN premium.

The JKN system is valid for healthcare services at community health centers, state and regional hospitals, private hospitals, clinics and registered doctors.

source: www.thejakartapost.com

Friday the Obama Administration announced a new initiative, the "Global Health Security Agenda (GHSA)," that addresses the looming threat of the global spread of infectious disease. The initiative's motto is "the need to prevent, detect, and respond to biological threats" as they relate to national security. Global pandemics can cause national risk through trade, exchange, and international travel, and the consequences can be profound both within and across the borders of countries.

The U.S. has forged global partnerships to address the threat of infectious disease. However, the odds are not good in that 80 percent of all world nations are not prepared to handle this massive issue. The U.S. will not take this on alone. Jordan Tappero, who is the Director of Global Health Protection at the Center for Global Health (Center for Disease Control/CDC) announced that the leader for the new initiative will be Health and Human Services. However, other U.S. Departments – namely, Defense, State and Agriculture – will also be key players. And, the U.S., in an effort to be part of a community of likeminded nations, will work together with international organizations. Joining them are the World Health Organization (WHO), the Food and Agriculture Organization and other groups across countries and regions. Currently a total of 26 collaborator countries are stakeholders with the U.S., including close allies as well as those with whom the U.S. is working to develop improved relations: China, India and Russia.

One of the challenges in bringing forth the plan from the Global Health Security Agenda initiative is the differing priorities of Defense and Health. Whereas Defense is concerned with national security risk, Health is geared towards the elimination of infectious disease and the affect on populations. Since the initiative must identify those diseases with greatest potential for significant national and international consequence, it must focus its efforts in that regard.

On a large scale, however, what the Global Health Security Agenda is addressing is just the tip of the proverbial iceberg. According to Salmaan Keshavjee MD, PhD, Director of Infectious Disease and Social Change, in Harvard Medical School's Global Health & Social Medicine, the root causes of infectious disease are both medical and social. The source is based in existing structures that are political, economic, religious, and social. Managing one aspect while overlooking the other will not be effective in eradicating disease.

This is particularly true because, even with the advent half a century ago of effective antibiotics, infectious disease is rampant in the majority of the world. In fact, bacterial, viral, and parasitic infections are the leading cause of mortality worldwide – causing one-third of all deaths.

In much the same way that the U.S. is serving as advocate and partnering with other nations to address the issue of infectious disease, grassroots organizations and international medical teams are doing so, as well. Partners in Health (PIH) has been at the center of health care transformation in global areas of poverty for the past 25 years. PIH and the Program in Infectious Disease and Social Change at HMS are using community health organizers or "accompagnateurs" to work with local peoples in Haiti, Ethiopia, rural Mexico, and other countries. By listening to needs and learning how to best reach those who most require help, these groups are pioneering on the ground level, making significant changes in education, health care, advocacy, and policy change.

Focus on global health security is an important first step towards the elimination of infectious disease. Government support for the organizations that are working to reduce infectious disease on global scale would help to move this issue forward.

source: guardianlv.com

Top administration officials joined representatives from federal agencies and 26 nations to launch an international effort that will help to boost the global capacity to prevent, detect and respond to disease outbreaks, Feb. 13.

At the Department of Health and Human Services headquarters, HHS Secretary Kathleen Sebelius and Lisa Monaco, assistant to the president for homeland security and counterterrorism, are speaking about the Global Health Security Agenda.

Joining them were officials from Finland, Germany, Canada, the United Kingdom, the Netherlands, Norway, Japan, South Korea China, India, Indonesia and other participating countries.

Representatives from three international organizations in Washington and Geneva, including the World Health Organization, were there, along with officials from the departments of State, Defense and Agriculture, and from the Centers for Disease Control and Prevention.

In advance of the international meeting, officials from the National Security Council, the Defense Department and CDC held a conference call with reporters to detail the U.S. plan to work even more closely with partners to strengthen the global disease response.

On the call were Laura Holgate, senior director for weapons of mass destruction, terrorism and threat reduction at the National Security Council; Andrew C. Weber, assistant secretary of defense for nuclear, chemical and biological defense programs; and CDC Director Dr. Tom Frieden.

"With the Global Health Security agreement, we're talking about making the world safer and more secure by strengthening our ability as an international community to prevent, detect and respond to infectious disease outbreaks," Holgate said.

Such diseases include Ebola and other hemorrhagic illnesses; flu; dengue fever; Middle East respiratory syndrome, or MERS; severe acute respiratory syndrome, or SARS; and other infectious diseases that arise in nature or that are accidentally or intentionally released, she added.

In 2007, most countries agreed to abide by updated International Health Regulations, or IHR, adopted two years earlier at the 58th World Health Assembly. The legally binding rules accepted country by country had been revised specifically to help in containing diseases that potentially could spread quickly worldwide.

The WHO set a five-year deadline for countries to ensure their national capacities to identify, investigate, assess and respond to such public health events. Continued...

source: www.dolphin-news.com

For decades, distribution of vaccines in Africa and other warm regions has been hampered by the need to keep the vaccines refrigerated - a major challenge in remote areas without electric power. But the World Health Organization says a new vaccine aimed at preventing meningitis A can withstand temperatures up to 40 degrees Celsius, and was found to be 100 percent effective during a trial study in Benin.

Researchers said that health workers in Benin have successfully immunized more than 155,000 people against meningitis A using the first vaccination to be approved for use without constant refrigeration, also known as the "cold chain."

The World Health Organization (WHO) said the vaccine, which is known as MenAfriVac, can be stored for up to four days in temperatures up to 40 degrees Celsius.

PATH is a U.S.-based non-profit organization that partnered with the WHO on the Meningitis Vaccine Project. Dr. Marie-Pierre Preziosi, the project's director, said the new breakthrough could revolutionize the way vaccination campaigns are conducted in developing countries. She spoke to VOA from Ouagadougou.

"As you know, vaccines are usually kept in cold chains, between 2 to 8 degrees Celsius. And so you have to have the whole capacity around the cold chain: that is freezers, ice packs, transportation fuel, electricity fuel, all of this. Sometimes, it is not only costly, but it is also very challenging to reach remote areas with such constraints," said Preziosi.

Health experts said that because of the cold chain requirement, there is normally a lot of wasted vaccine vials during immunization campaigns, particularly during the "last mile" -- the time from when the vaccine leaves the refrigerator at the district health center until it is injected into a person's arm at the village level.

Many communities in Africa have no access to electricity and are often too remote to be reached before the ice packs in insulated coolers melt.

Preziosi said the flexibility of being able to transport the vaccine outside of the cold chain meant that only nine vaccine vials out of 15,000 had to be discarded during the trial study in Benin.

Being able to work outside the cold chain also meant that health workers didn't have to travel to and from the district health center each day to replenish vaccine supplies. This allowed them to vaccinate more people in a shorter amount of time.

PATH's vice president for product development, Dr. David Kaslow, said that removing the refrigeration requirement for MenAfriVac could also reduce costs.

"The one study that was done with the WHO looked at the modeled scenario, which is: what are all the costs that are incurred in that last mile? And really, one of the major costs, obviously, are the cold chain costs themselves... And so the analysis was done as to what is the cost savings. And it's about 50 percent," he noted. "On average, from 24 cents per dose delivered to 12 cents per dose delivered."

Meningitis, which is the inflammation of the protective tissue that covers the brain and spinal cord, can lead to severe brain damage if left untreated and results in death in about 50 percent of cases.

The WHO said that while meningitis can be prevented with vaccines, more than one million suspected cases have been reported by countries in Africa's "meningitis belt" over the past 20 years.

The Meningitis Vaccine Project said that following the MenAfriVac vaccination campaign in Benin, there were no reported cases of Meningitis A in any of the 150 vaccinated communities.

Kaslow said that it is now up to individual countries to take advantage of this success and allow health workers to use MenAfriVac within the new temperature conditions.

He said the next step will be for pharmaceutical developers to see if the refrigeration requirements for other vaccines, such as cholera, can also be changed.

source: www.voanews.com

HONG KONG--Plagued by cost overruns and a US$4.2 billion deficit, Taiwan's National Health Insurance set out in 2012 to find out what lay behind the problem.

The results were a mixture of the expected and unexpected. Other cities, it turned out, were not paying their fair share, so the entire cost fell on Taipei. At the same time, patients were visiting hospitals more than anywhere else in the world and being prescribed many more drugs than they needed or could ever take.

In one instance, a patient who suffered from a range of ailments from high blood pressure to heart disease and asthma was given enough pharmaceutical products to last him 22 years, said Lee Chun-fu, an official with the Bureau of National Health Insurance that runs Taiwan's healthcare system.

The issue of over-prescription of pharmaceuticals is visible not only in Taiwan but around the world.

The World Health Organization (WHO) estimates that as many as half of all medicines are inappropriately prescribed, dispensed or sold. Overprescription of medicine and overtreatment is emerging as a significant problem across Asia, one that governments are working to address.

For the WHO, the concern is health related. Medicines that are not prescribed properly can lead to health problems. Take antibiotics, for example. If not properly prescribed and taken, they can lead to the emergence of resistant bacteria.

This is already a problem with diseases such as tuberculosis, of which there are resistant strains emerging globally.

"Antibiotic resistance is rising for many different pathogens that are threats to health," said Tom Frieden, director of the U.S. Center for Disease Control and Prevention.

Another problem is fiscal. Improper or overprescription of drugs leads to huge cost overruns. This may be most visible in Taiwan.

Taiwan's healthcare system operates through a national health insurance, which covers the entire population. Hospitals buy drugs directly from drug companies and sell them on to patients, although the National Health Insurance covers most of the cost.

The larger hospitals have the clout to negotiate steep discounts with the pharmaceutical companies and can make a tidy profit in the difference between what they pay for a drug and the fixed price that the government pays them.

It benefits doctors to prescribe as much as possible. A spokesperson for the National Health Insurance Civic Surveillance Alliance said the system puts a cap on prices for medicines but not on the quantities that are prescribed or distributed.

This "black hole" costs around US$340 million a year. In the last 15 years or so, Taiwan's healthcare system has racked up some US$4.2 billion in deficits.

The problem is hardly unique to Taiwan.

Japan, which also has a well-established system of universal care under its national health insurance, has been under severe stress for several years, notes McKinsey & Co. Ltd., a management consulting firm.

Part of the problem is that rising wealth across the country encourages people to seek more care that combines with a lack of centralized controls over the allocation of resources.

Japan's system of healthcare, known as kaihoken, was established in 1961. But in the past few years, a shortage of doctors has emerged. McKinsey's 2011 findings note that some doctors see as many as 100 patients in a single day. Under such high levels of turnover, they tend to overprescribe drugs. This also helps the clinics that own in-house pharmacies.

Limit Services to Reduce Cost in Japan

source: www.chinapost.com.tw

Just a few weeks ago, 11-month-old Shaista was pulling herself up, giggling as she took her first wobbly steps with the helping hand of her teenage mother.

Then the polio virus struck and Shaista was no longer able to stand, her legs buckling beneath her weight. Today, her mother cries a lot and wonders what will become of her daughter in Pakistan's male-dominated society, where a woman's value is often measured by the quality of her husband.

"It is not a hardship just for the child, but for the whole family," said the child's 18-year-old mother, Samia Gul. "It is very difficult for a poor family like us. She will be dependent on us for the rest of her life."

Shaista is one of five new polio cases to surface in Pakistan in just the first month of this year. Last year, Pakistan recorded 92 new cases, beating Nigeria and Afghanistan — the only other polio-endemic countries — by almost 2 to 1, the World Health Organization said.

Pakistan's beleaguered battle to eradicate polio is threatening a global, multi-billion-dollar campaign to wipe out the disease worldwide. Because of Pakistan, the virus is spreading to countries that were previously polio-free, U.N officials say.

"The largest polio virus reservoir of the world," is in Peshawar, in northwestern Pakistan near the border with Afghanistan, according to WHO.

Shaista and her parents share a two-room mud house with a couple of goats, a half-dozen squawking chickens and 10 other relatives in Pakistan's western Khyber Pukhtunkhwa, or KPK, province, where Islamic militants often gun down health workers distributing vaccines and send suicide bombers to blow up police vehicles that protect them.

Fresh cases of polio — traced through genetic sequencing to the Pakistani strain of the disease — are showing up in countries that were previously polio-free, including Syria and Egypt, as well as in the Gaza Strip, said Ban Khalid Al-Dhayi, the spokeswoman for UNICEF in Pakistan. UNICEF is tasked with persuading a reluctant tribal population that lives along Pakistan's border with Afghanistan — perhaps one of the most dangerous places on the planet — to vaccinate their children.

"A lot of countries that spent so much money and resources eradicating polio are worried," Al-Dhayi said in an interview.

It wasn't so long ago — 1988 — that more than 350,000 people, most of them children under 5, were afflicted by polio in 125 countries where the disease was endemic. Today the disease is endemic in only three.

Last year, the Bill and Melinda Gates Foundation, a multi-billion-dollar charity that funds polio vaccinations, vowed to wipe out the crippling disease by 2018.

Underlining the danger that Pakistan poses to achieving that goal, Al-Dhayi said there are 350,000 Pakistani children in just one small area of the country who have not been vaccinated.

The area — North and South Waziristan — is too dangerous for health workers to venture. Islamic militants, many with ties to al-Qaida, banned polio vaccinations there in 2012 to press their demand that the United States end its use of drones to target their hideouts.

Militants have also created suspicion among ultraconservative parents in Pakistan's deeply religious northwest, saying the polio vaccine will make their children impotent. The vaccine, they claim, is a ploy by the West to limit the world's Muslim population.

But health workers and militants alike agree the biggest setback was the highly publicized use of a Pakistani doctor and a vaccination ruse to ferret out al-Qaida chief Osama bin Laden in May 2011. Dr. Shakil Afridi is in jail in Pakistan for his role in the CIA operation that uncovered bin Laden's hideout.

While Afridi never got DNA samples from the bin Laden family, his involvement in the covert operation that led to bin Laden's death caused residents to look with suspicion on many vaccination programs. Devastating for the polio campaign were the images of Afridi standing beside a banner promoting polio vaccinations as television commentators told of his collusion with the CIA.

"We have deep sensitivity about the polio vaccination after the martyrdom of the great mujahed and leader of Muslims, Sheikh Osama bin Laden," Taliban spokesman Ehsanullah Ehsan told The Associated Press. "We still have strong suspicions that the vaccination campaign could be used again and again to spy on Muslims and the mujahedeen."

UNICEF is trying to get Pakistan's senior Islamic clergy to support the polio campaign, with some success, according to Al-Dhayi. Among those recruited is the so-called father of Afghanistan's Taliban movement, Maulana Sami-ul-Haq.

"The effort is really intensive and proving positive," she said, but the clock is ticking. "Pakistan is the worst of the three (polio-endemic countries) in terms of the number of cases and the complexity."

source: www.dailytribune.com

Kalbe Farma, a local pharmaceutical firm, sets aside Rp 500 billion ($41.3 million) to finance its planned acquisition of a health-food producer this year.

The company will fund the acquisition from its own funds.

"The acquisition fund doesn't come from our capital expenditure this year," said Vidjongtius, finance director at Kalbe Farma as quoted by the Investor Daily.

Kalbe has been scouting the market and been in talks with more than 10 companies in Indonesia. The report did not identify the potential acquisition targets.

Unilever Indonesia is one of the listed food companies in the country.

Kalbe Farma said on Wednesday that it has allocated between Rp 1 trillion and Rp 1.2 trillion for capital expenditure this year to boost its production capacity.

The company also aims its sales growth and net income to reach 14 percent and 16 percent, respectively, supported by the development of each division.

"Kalbe plans to introduce three to five products of each division this year," said Irawati Setiady, president director at Kalbe Farma, as quoted by the Investor Daily.

The company will keep on developing its unbranded generic medicines, which it has been producing in Cikarang, West Java, since 2012. It has also completed its oncology production facility in Pulogadung, East Jakarta, on Jan. 23, it said in the press release.

In its fast-food division, Kalbe plans to continue the construction of a production facility for nutritional drinks, which is expected to be completed in mid-2015.

The company seeks to develop into a global brand with a presence in countries such as the Philippines, Vietnam, Myanmar, and Nigeria.

It will expand its sales area and boost its export to 5 percent from below 4 percent previously.

"We usually work together with local companies to help distribution," Kalbe said as quoted by Investor Daily.

The company has built a plant in Nigeria, which focuses on medicine and food production.

The company reported a 17.4 percent increase in revenue to Rp 16.01 trillion last year compared to the year before. Its net income rose 10.8 percent last year from the previous year.

Shares of Kalbe Farma rose 0.7 percent to Rp 1,410 on the Indonesia Stock Exchange on Wednesday.

source: www.thejakartaglobe.com

Now that wealthy nations have a simple pill regimen that can cure hepatitis C, calls are mounting from representatives of poor nations for the same drugs.

In December, the Food and Drug Administration approved sofosbuvir, from Gilead Sciences. Under the brand name Sovaldi in the United States, it is expected to cost $84,000 per treatment. Four other companies are developing similar pills expected to reach the market in the next three years, with similarly high price tags.

Worldwide, at least 150 million people — nearly five times the number with H.I.V. — are believed to have hepatitis C, which can cause liver damage and cancer.

The Access Campaign of Doctors Without Borders has estimated that cocktails of sofosbuvir and similar drugs can be made for $250 or less, and it is lobbying to make that possible, said Rohit Malpani, the campaign's policy chief.

It will ask the World Health Organization to put sofosbuvir on its list of drugs the agency tests for countries too poor to have their own drug regulatory agencies.

It is opposing Gilead's patent application for sofosbuvir in India. Gilead, meanwhile, hopes to license Indian drug companies to make a $2,000-per-treatment version.

The campaign also plans to ask the three top funders of the war on AIDS — the Global Fund to Fight AIDS, Tuberculosis and Malaria; the President's Emergency Plan for AIDS Relief; and Unitaid — to agree to pay for hepatitis drugs too if the prices become affordable, which will let Doctors Without Borders start pilot treatment projects in several countries.

source: www.nytimes.com