The majority of revenue the government reaps from the proposed cigarette excise increase should be used to improve prevention-centered programs and healthcare services for people with smoking-related health problems, a lawmaker said.

"As we know, Indonesia's cigarette excise revenue amounts to almost Rp 140 trillion [US$10.5 billion] now, and if it increases, especially because of the cigarette excise increase currently debated by all elements of society, the government should allocate more of the revenues to healthcare services," Dede Yusuf, chairman of House Commission IX overseeing health and labor affairs, told The Jakarta Post on Wednesday.

In its recent survey on cigarette prices, the University of Indonesia's (UI) Center for Health Economics and Policy Studies found that around three-quarters of 1,000 respondents, including smokers, agreed cigarette prices should be increased to up to Rp 50,000 per pack. They also agreed the excise revenues should be used to fund the national health insurance (JKN) program.

It was earlier reported that as of April, the Health Care and Social Security Agency (BPJS Kesehatan) had suffered from Rp 7 trillion worth of losses from the JKN program.

In Indonesia, cigarettes are priced within a range of between Rp 12,000 to Rp 20,000 per pack. Cigarette tax revenues collected amounted to Rp 139.5 trillion in 2015.

However, Dede said, the use of the tax revenues had not been prioritized to fund and improve healthcare services in the country. With such huge revenues, he said, the government should be able to allocate more funds to improve community healthcare centers (Puskesmas) and dispatch more health workers to disadvantaged and outermost areas. (wnd/ebf)

http://www.thejakartapost.com/

One of the top US public health officials on Sunday warned that the mosquito-borne Zika virus could extend its reach across the US Gulf Coast after officials last week confirmed it as active in the popular tourist destination of Miami Beach.

The possibility of transmission in Gulf States such as Louisiana and Texas will likely fuel concerns that the virus, which has been shown to cause the severe birth defect known as microcephaly, could spread across the continental United States, even though officials have played down such an outcome.

Concern has mounted since confirmation that Zika has expanded into a second region of the tourist hub of Miami-Dade County in Florida. Miami's Wynwood arts neighborhood last month became the site of the first locally transmitted cases of Zika in the continental United States.

"It would not be surprising we would see additional cases perhaps in other Gulf Coast states," Dr. Anthony Fauci, director of the allergy and infectious diseases unit of the National Institutes of Health (NIH), said in an interview on Sunday morning with ABC News.

Fauci noted that record flooding this month in Louisiana - which has killed at least 13 people and damaged some 60,000 homes damaged - has boosted the likelihood Zika will spread into that state.

"There's going to be a lot of problems getting rid of standing water" that could stymie the mosquito control efforts that are the best way to control Zika's spread, he said.

US health officials have concluded that Zika infections in pregnant women can cause microcephaly, a birth defect marked by small head size that can lead to severe developmental problems in babies. The connection between Zika and microcephaly first came to light last fall in Brazil, which has now confirmed 1,835 cases of microcephaly that it considers to be related to Zika infections in the mothers.

On Friday, Florida Governor Rick Scott confirmed that state health officials had identified five cases of Zika believed to be contracted in Miami Beach.
The US Centers for Disease Control and Prevention told pregnant women they should avoid the trendy area and suggested those especially worried about exposure might consider avoiding all of Miami-Dade County.

NIH's Fauci on Sunday said the conditions of most of the country make it unlikely there would be a "diffuse, broad outbreak," even though officials need to prepare for that possibility.

He compared it with diseases such as Dengue, which is endemic in certain tropical and subtropical regions of the world but rarely occurs in the continental United States. In Miami's Wynwood area, experts have seen "substantial" knockdowns of mosquito populations.

Still, its containment is more complicated because Zika can be sexually transmitted, Fauci said.

"This is something that could hang around for a year or two," he said.

The World Health Organization has said there is strong scientific consensus that Zika can also cause Guillain-Barre, a rare neurological syndrome that causes temporary paralysis in adults.

http://www.hindustantimes.com/

The Jakarta Police had investigated reports of alleged fake Healthcare and Social Agency (BPJS Kesehatan) membership cards in Koja, North Jakarta on Friday, said police spokesperson Sr. Comr . Awi Setiyono.

"We received a report from Suhajoyo and Isti Komaesih, a couple from Koja. They registered for health treatment at Koja community health center (Puskesmas) on July 26," Awi told journalists recently.

The Puskesmas head, Anita Yuliasari, directed them to administration department staff to verify the documents. Unfortunately, the staff could not the couple's data.

They reported their case to Koja sub-district head, Depika Romadi. "Suhajoyo and Isti reported to the sub-district head that they had registered the card with the head of RT 08 in Koja, with initials DF, who has issued 28 fake membership cards for seven families in his neighborhood," Awi said.

Separately, Cimahi Police in West Java uncovered the distribution and use of fake membership cards for BPJS Kesehatan last month. The finding was made possible following a complaint filed by Budiyanto from Padalarang, West Java, who was denied access to Cibabat Regional Hospital to obtain a meningitis vaccine. The hospital management said his BPJS Kesehatan card was fake. (rez/dan)

http://www.thejakartapost.com/

After a successful trial in rhesus monkeys, a team of researchers, including doctors from Boston's Beth Israel Deaconess Medical Center, is ready to start testing a Zika virus vaccine in humans, they announced this week.

U.S. Sen. Ed Markey, a Massachusetts Democrat who joined the team in Boston, chastised his Republican colleagues for withholding $1.9 billion in funding requested by President Barack Obama even as the virus has turned up in mosquitoes in South Florida.

Authorities believe the virus can cause devastating birth defects when pregnant women are infected, and confirmation of recent infections caused the Centers for Disease Control and Prevention on Monday to recommend against travel to a Miami neighborhood.

"There are people from Massachusetts and all across America who are canceling their vacations to Florida. Well, Congress should cancel its vacation, go back into session to fund the $1.9 billion," Markey said at a press conference.

The mosquito-borne virus, believed to cause microcephaly and other problems in infants, was identified in humans in Uganda and Tanzania in 1952, according to the World Health Organization, which declared a world health emergency Feb. 1 as the virus exploded in Latin America.

"We do expect to see more Zika cases," President Barack Obama said during a Thursday press conference where he criticized Congress for going on recess before funding Zika efforts. He added, "The situation is getting critical," saying a vaccine is "well within reach," but could be delayed by lack of funding.

In a Feb. 22 letter to Congress, Obama said the $1.9 billion would support efforts to "fortify domestic public health systems," speed research and development of vaccines, provide emergency assistance to states and territories to fight the virus and provide services for pregnant women in Puerto Rico and elsewhere, among other initiatives.

Beth Israel Deaconess — Harvard Medical School's teaching hospital — teamed up with Walter Reed Army Institute of Research and the University of Sao Paulo, in Brazil, to study three vaccine candidates, which were found to provide "complete protection" against Zika in rhesus monkeys.

Saying the findings "raise optimism" for eventually developing a Zika vaccine for people, Dan Barouch, a senior author of the findings published in Science, said clinical trials would begin in the fall with 30 to 50 human participants testing the safety of the regimen. Markey said "efficacy tests" in people would require thousands of human participants and cost "hundreds of millions of dollars."

"By next summer, perhaps, it is there to be given as a vaccine, all over America, all over Latin America and the world, but the funding has to be there. A vision without funding is a hallucination," Markey said.

Barouch, who is director of the Center for Virology and Vaccine Research at Beth Israel, said the plan would be for a vaccine that could be distributed similarly to flu shots, and he said authorities would "first concentrate on the highest-risk groups" in distributing vaccines.

The group tested three different versions of vaccine candidates, including a "purified inactivated virus," which is essentially a dead virus, along with a "plasmid DNA vaccine and an adenovirus vector-based vaccine," produced at Beth Israel Deaconess.

The tests were "strikingly effective, and no adverse effects were observed," according to Beth Israel Deaconess. Barouch said two other vaccines are under development, including one at the National Institutes of Health, and safety tests in humans are just beginning.

"We are very supportive of all those programs," Barouch said.

Markey said the virus would not be contained in Florida, urging Republicans to join the call for funding Zika research and prevention efforts.
"Miami, Florida, is just the beginning of the story. It is going to spread inevitably, inextricably to city-to-city, state-to-state, all across our country, but all across the planet as well. This disease is just one plane ride away from downtown Boston," Markey said.

He added, "I think it's great that (Florida Sen.) Marco Rubio and (Florida) Governor (Rick) Scott are calling for funding. It would be better if we heard (presidential candidate) Donald Trump calling for the funding; if we heard (House Speaker) Paul Ryan and (Senate Majority Leader) Mitch McConnell calling for the funding and that we would go back into session for one-half day in August and pass the $1.9 billion."

http://www.dailycommercial.com

In a little more than a month's time the world will mark the first anniversary of the adoption of the Sustainable Development Goals — the first-ever global to-do list for a fairer, safer and healthier world by 2030.

Much has been written about the expanded scope of the goals relative to the Millennium Development Goals, and the complex links that bind them all together. Among the health-related targets, some represent the unfinished business of the MDG era, and some are new targets that reflect changing disease patterns and the challenge of aging populations.

But none are more significant than target 3.8: achieving universal health coverage. The UHC target is the linchpin of the health-related SDGs; the one target that, if achieved, will help to deliver all the others by providing both population and person-centered high-quality services that are free at the point of delivery and designed to meet the realities of different people's lives.

Of course, UHC is not a new concept, but its inclusion in the SDG agenda is a significant acknowledgment by the nations of the world that progressing toward UHC will not only improve the health of millions, but will also contribute to reaching many of the other SDGs. Over the past five years or so, more than 70 countries have asked the World Health Organization to help them progress toward UHC.

Moving toward UHC

One important step is to agree on how to measure it. Two indicators have been selected for UHC: one that measures the level of coverage in a population by tracking access to a set of eight core health services, and another that measures the extent to which people are exposed to financial hardship through out-of-pocket expenditure on those services.

Both are important because they capture the twin imperatives of UHC: that people and populations receive the health services they need, without facing financial hardship. WHO estimates that about 150 million people around the world suffer financial catastrophe annually from out-of-pocket expenditure on health services, while 100 million people are pushed below the poverty line.

There is no one-size-fits-all approach to achieving UHC. There are, however, several common unavoidable truths that we must all face. Aging populations and the burgeoning burden of noncommunicable diseases present unique challenges that will require all countries to find innovative ways to reshape their health systems.

One of the first requirements will be a radical transformation of the health workforce. The global economy is projected to create demand for 40 million new health workers by 2030, but most of those jobs will be created in the wealthiest countries. Low and lower-middle income countries need 18 million more health workers if they are to achieve UHC. Without urgent action, that mismatch will widen.

A view to future investment

The High-Level Commission on Health Employment and Economic Growth, chaired by President François Hollande of France and President Jacob Zuma of South Africa, will next month deliver a set of recommendations on how to address this challenge. Among them will be a call for countries to see their health workers as an investment, instead of a cost. Investments in the education, training, work conditions, financing and deployment of health workers will pay handsome dividends, not only for the health of populations, but for economies, health security and gender equity.

A second major challenge is the ever-increasing price of medicines. Recently-approved drugs for cancer and hepatitis C hold enormous promise, but come with eye-watering price tags that put them out of reach for most of the people who need them.

A study published in PLOS Medicine at the end of May found that, after adjusting for average 2015 exchange rates and purchasing power, the cost of treating the entire hepatitis C-infected population in each of 30 countries would range from 10.5 percent of total pharmaceutical expenditure in the Netherlands to 190.5 percent in Poland. In 12 countries, the price of a 12-week course of sofosbuvir (the medicine concerned) was equivalent to one year or more of the average annual wage, ranging from 0.2 in Egypt to 5.3 in Turkey.

Last year, WHO included several new treatments for cancer and hepatitis C on its "essential medicines list," a statement that innovative technologies with the potential to cure or significantly alter the course of deadly diseases are not luxury items for the privileged few; they are public goods to which access must be equitable.

The difficulty lies in assessing what represents a fair profit margin for pharmaceutical companies, especially when returns for shareholders are prioritised over access to lifesaving medicines. That assessment is hindered by the lack of transparency around exactly how the prices of medicines are set. Research and development investments are clearly needed, but their real cost is unclear. Information on the patent status of essential medicines is also not easy to obtain, making it difficult for countries to assess whether they can procure generic medicines or produce them locally.

To that end, WHO is planning to convene governments, patient groups and industry stakeholders to discuss principles for a fair pricing model that can affordably deliver the medicines needed by patients while keeping companies interested in developing new and better treatments and producing generic treatments. This may require reconsideration of the need for transparency, full understanding of what it costs to develop a new product, as well as understanding the minimum profit needed to keep production going.

Achieving UHC, like all of the SDGs, is a challenge for all countries, rich and poor. All nations will have to take steps to reform their health workforce and address the affordability of medicines. No one can afford a business-as-usual approach. Nor does anyone pretend that UHC can or will be achieved with a snap of the fingers. The challenges are serious, although not insurmountable. But if the world leaders who signed up to the SDGs are to deliver on their promises, they must be prepared to take bold action to deliver on UHC.

https://www.devex.com/

BEIJING, A new report says China can offer better health care for its citizens at affordable costs if it restructures its delivery model to focus on providing integrated primary care for its rapidly aging population, and reforming public hospitals so they mainly treat complex and acute cases.

Switching to "people-centered, integrated care" would keep routine patient care outside of hospitals and help China cut down on health costs by as much as 3 percent of its gross domestic product (GDP) by 2035, according to the report conducted by the World Bank and the World Health Organization, the Ministry of Finance, the National Health and Family Planning Commission, and the Ministry of Human Resources and Social Protection of China. The savings, according to Bank estimates, is projected to be in the hundreds of billions of dollars annually.

Business as usual, however, would increase health spending by 8.4 percent a year from 2015 to 2020, faster than the projected GDP growth of 6.5 percent a year.

"Decades ago, China's innovations in health such as barefoot doctors and cooperative health care showed the world it was possible to improve the health and greatly increase the life expectancy for hundreds of millions of people," said World Bank Group President Jim Yong Kim. "Today, China can once again lead the way with cutting-edge primary health care reform that puts the patient first and shifts away from expensive hospital care that often does little to improve the health of people. If China institutes these reforms, we believe it will improve the health care system for all Chinese—or one in every six people in the world."

The report, Deepening Health Reform in China, is the most comprehensive report so far about China's health reform. Two years in the making, it is based on 20 background studies, more than 30 case studies, visits to 21 provinces in China, and a series of technical workshops with a diverse team of policy makers, practitioners, researchers and academicians from all three partners.

Success and challenges in China's health care systems

The report comes as the Chinese government embarks on health reforms under the 13th Five-Year Development plan, including legislation that would set parameters of the health sector.

Its recommendations are built on China's impressive success in health care over the last two decades. With massive investments in health infrastructure, the country achieved near-universal health insurance coverage at an unprecedented speed, with more than 95 percent of its population covered by 2011. This helped reduce child and maternal mortality rates; a child born in China today can expect to live more than 30 years longer than he would 50 years ago.

But China's health costs have been growing because of rising incomes and expansion of health insurance to almost all citizens. After lifting more than 600 million people out of poverty amid double-digit growth in the last three decades, China now faces slower growth and emerging challenges common to a better-off society.

China faces emerging challenges to meet the healthcare needs of its citizen, due to a rapidly aging society and the increasing burden of non-communicable diseases, such as cancer and heart disease. There are now 140 million people older than 65 years in China, and that is expected to increase to 230 million by 2030. Infectious diseases have been replaced by non-communicable diseases as the greatest health threat, accounting for more than 80 percent of the 10.3 million deaths every year. Those diseases are exacerbated by high-risk behaviors such as smoking, sedentary lifestyles and alcohol consumption, as well as environmental factors such as air pollution. At the same time, with higher economic growth and personal incomes, people are demanding more and better health care.

That has put pressure on the health care system. According to the report, health gains have slowed, but healthcare spending has been growing at a rate of 5 to 10 percentage points higher than GDP growth since 2005. Out-of-pocket expenditures have eased significantly in recent years, but at 32 percent of total spending in 2014, the rate is still higher than the average of 21 percent among high-income economies.

Recognizing the challenges, Chinese Premier Li Keqiang agreed with the World Bank Group president and World Health Organization director general in 2014 to prepare this study.

The report details a series of recommendations on the practical and concrete actions required to build a healthcare system for the future, through improved service provision and the creation of a financial and institutional environment for the improved care.

People-centered integrated care

At the core of the report's recommendations is the full adoption of a people-centered integrated care model. The bedrock of this type of model is a strong primary care system that is integrated with more advanced care, especially for patients with chronic illness such as cancer and diabetes.

Another recommended way to improve to China's healthcare system is to reform public hospitals so they are no longer a one-stop shop for all health services, but instead are used for more acute care with primary care provider covering routine care.

A more effective system would also change incentives for providers so they are rewarded for good health outcomes for patients instead of for the volume of care, which is a major driver of health costs.

The report recommends boosting the status of primary care providers so they are better paid and supported, to ensure a competent health workforce that people can trust.

It also supports allowing qualified private health providers to compete on a level playing field with the public sector to deliver cost-effective services.

And finally, the report suggests that a national authority to oversee quality improvements across the system could be considered by China.

The report urges China to incorporate the proposed changes in a coordinated and deliberate manner. It said it will likely take about 10 years for China to fully implement the proposed reforms.

http://www.worldbank.org

Indonesian President Joko Widodo signed Presidential Instruction No. 6/2016 on the Acceleration of Development of the Pharmaceutical Industry and Medical Devices on 8 June 2016. Through this instruction Widodo calls on all relevant ministries - including the Health Ministry, Industry Ministry and Finance Ministry - to take efforts to boost development of Indonesia's pharmaceutical industry. The Health Industry has a key task to write an action plan for the development of a self-sufficient pharmaceutical industry and to boost competitiveness.

Indonesia's pharmaceutical industry is highly dependent - for some 90 percent - on imports of raw materials from abroad. Considering that sales in the nation's pharmaceutical industry are expanding by around 10 percent year-on-year (y/y), it implies imports of raw materials will continue to rise, especially now the Indonesian government is eager to turn its ambitious universal healthcare scheme (in Indonesian: Jaminan Kesehatan Nasional, or JKN) into a success. JKN, which was implemented by the social security agency Badan Penyelenggara Jaminan Sosial Kesehatan (BPJS) in early 2014, aims to provide all Indonesian citizens with access to a wide range of health services (by 2019). If conditions do not change but the JKN program is a success, then it would imply a significant surge in imports of raw materials, putting pressure on Indonesia's trade and current account balances.

The presidential instruction also orders the Health Ministry to create an integrated data system that covers the demand, production and distribution of pharmaceutical supplies and healthcare services. Meanwhile, the process to obtain permits to develop a pharmaceutical factory should be simplified. Furthermore, BPJS needs to improve its capacity to pay bills submitted by local hospitals and health clinics.

Earlier this year we reported about the growing mismatch between claims paid and premiums received by BPJS. The subsequent growing deficit undermines the financial sustainability of the whole program. Moreover, given that 90 percent of medicines' raw materials are imported, part of BPJS' funds (taken from the central government's state budget) flow abroad.

Presidential Instruction No. 6/2016 also calls on Indonesia's Finance Ministry to provide fiscal incentives in order to attract investment in the pharmaceutical industry. Also the Indonesia Investment Coordinating Board (BKPM), the government agency that provides investment services, is tasked to create new policies that boost investment in this sector.

Earlier this year the Indonesian government had already widened room for foreign ownership in factories that produce raw materials for medicines from 85 percent to full 100 percent foreign ownership. However, more incentives are needed to attract investment.

http://www.indonesia-investments.com/

In June 1981, the Centers for Disease Control announced that a strange infection was showing up in Los Angeles.

Five patients had severely weakened immune systems, and many were suffering from an extremely rare form of pneumonia. Doctors couldn't figure out how a cluster of previously healthy, young gay men had gotten so sick so quickly.

The warning from Los Angeles was soon followed by reports of similar cases in New York, San Francisco, and other cities.

By the end of that year, at least 121 people had died from the then-mysterious disease. By the end of the decade, the syndrome, which we now know as AIDS, had become a pandemic, taking more than 59,000 American lives. Worldwide, the World Health Organization (WHO) estimated, there were up to 400,000 cases.

Since the beginning of the epidemic, AIDS has claimed about 34 million lives. And there are an estimated 36.7 million people worldwide currently living with HIV, the virus that causes AIDS. It's still the leading cause of death for women of reproductive age (15-44) worldwide.

But the tide is finally turning, and stopping a disease that once seemed unbeatable is now very much within our reach.

A plan to end AIDS
On June 8, almost exactly 35 years since the start of the AIDS crisis, the United Nations announced a new set of goals that would put the world on track to end the epidemic by 2030. That's not only amazing, but entirely possible.

AIDS, or acquired immunodeficiency syndrome, is a disease caused by human immunodeficiency virus, or HIV. The virus attacks the immune system, specifically infection-fighting CD4 or T cells, until the body no longer can defend itself from opportunistic infections. Doctors diagnose a patient with AIDS, the final stage of HIV, when they develop opportunistic infections or the concentration of CD4 cells falls below a certain point. HIV is transmitted through blood and other bodily fluids — most people contract it through unprotected sex or intravenous drug use with contaminated needles. Mothers can also transmit the virus to their children during pregnancy or breastfeeding.

The targets set out in what's called the UNAIDS Fast-Track plan are ambitious, but important. The first goal is the 90-90-90 target: By 2020, 90% of people with HIV will know they're infected, 90% of those who know will have access to treatment, and 90% of people in treatment will be successfully suppressing the levels of the virus in their system. Also by 2020, the UN hopes to see 500,000 or fewer new infections among adults.

By 2030, the UN has set a goal to limit new infections among adults to 200,000, with treatment goals boosted to 95-95-95.

We've already come so far

That may sounds like a tall order, but the strides made in the fight against AIDS in rich countries is tremendous. In the United States, deaths from AIDS-related illnesses peaked in the early 1990s and have fallen steadily ever since.

Globally, the most devastating year was 2005, when AIDS killed 2 million people, but that number's been falling too — down to 1.1 million in 2015. New infections have declined by 6%, and among children, new cases are down 50%. On Monday, Australia announced that AIDS was "no longer a public health issue" in the country, according to Reuters.

With access to treatment, HIV is far from the death sentence it was at the height of the American epidemic — by blocking the growth of HIV cells with antiretroviral drugs, patients can live with HIV longer than ever and even avoid AIDS altogether. The risk of a pregnant mother transmitting HIV to her child can now be reduced to less than 5% with proper medical intervention.

As treatment has improved, so has prevention. A study released in the Journal of the American Medical Association (JAMA) on Tuesday tracking long-term, committed couples with different HIV statuses showed that antiretroviral therapy can also prevent an HIV-positive person from transmitting the virus to their uninfected partner.

In 2012, the Food and Drug Administration approved a combination of drugs called Pre-Exposure Porphylaxis, or PrEP, which can reduce the risk of infection by up to 92% for daily users.

'The issue is access'
Right now, the UN estimates that only 57% of people living with HIV know their status, and fewer than half have access to antiretroviral treatment. The rates of new infection are on the rise again — even in Australia, where HIV diagnoses actually rose by 13% over the past decade, despite the plummet in cases of full-blown AIDS.

And while treatment and prevention options have improved drastically, there are stark disparities in who has access to those options around the world.

"Today, we have multiple prevention options," said Michel Sidibé, executive director the UN's AIDS program, in a press release. "The issue is access — if people do not feel safe or have the means to access combination HIV prevention services we will not end this epidemic."

Which is why one another important number in the plan the global AIDS epidemic is zero: Zero discrimination against people living with or vulnerable to HIV infection.

http://www.techinsider.io/