WHO urges countries to meet health-related MDGs

HANOI, 26 September 2012-"With the deadline for attainment of the Millennium Development Goals (MDGs) only three years away, wide disparities between and within countries need to be urgently addressed if the goals are to truly benefit vulnerable populations," World Health Organization (WHO) Regional Director for the Western Pacific Dr Shin Young-soo said today.

"Unless urgent action is taken, we will likely fall short in some areas, especially in reducing maternal and child mortality and improving maternal health," Dr Shin told the WHO Regional Committee for the Western Pacific in Hanoi, convened to review WHO's work in the Region. "The battle must continue."

The under-five mortality rate has dropped by 60% in the Region, from 48 deaths per 1000 in 1990 to 19 per 1000 in 2010. However, six countries still account for an estimated 97% of the under-five deaths-Cambodia, China, the Lao People Democratic Republic, Papua New Guinea, the Philippines and Viet Nam.

Disparities in child mortality also persist within countries. In Cambodia, for example, the overall under-five mortality rate is 54 per 1000 live births. However, it ranges from 18 per 1000 live births for areas with the highest socioeconomic status to 118 per 1000 live births among the poor.

Urban versus rural disparities also exist, such as in the Philippines, where the under-five mortality rate is 28 per 1000 live births in urban areas and 46 per 1000 in rural areas.

Despite a decreasing trend in maternal mortality in most countries and areas in the Western Pacific, large disparities and inequalities exist both between and within countries. In low-income countries, such as the Lao People's Democratic Republic, the maternal mortality ratio (MMR) is 470 per 100 000 live births - far higher than in middle-income countries, such as Malaysia, where the ratio is 29 per 100 000, and Viet Nam with 59 per 100 000. The MMRs in Cambodia and Papua New Guinea also remain high at 250 and 230 per 100 000 live births, respectively.

In the Region, the HIV epidemic has shown signs of stabilizing with increased coverage of preventive interventions for most-at-risk populations. However, only 43% of those who need treatment for HIV have access to antiretroviral drugs. Access to treatment still needs to be scaled up, particularly in low- and middle-income countries.

Lack of universal access to health care is also a pressing issue, with high costs and direct out-of-pocket payments putting health care beyond the reach of many people in the Region. Other barriers include weak health systems and widening health inequities. Also, countries need more reliable civil registration and vital statistics systems to better monitor the burden of diseases and properly target health interventions.

"Universal coverage needs to be improved to enable people to have access to good-quality services without being financially strapped," said Dr Shin. "Particular attention should be given to underserved groups. Failure to act now will further widen health inequities."

(sumber : nzdoctor.co.nz)

Post-2015 MDGs development agenda

President Susilo Bambang Yudhoyono is in New York with an important mission for humankind. He, alongside British Prime Minister David Cameron and Liberian President Ellen Johnson Sirleaf, will be co-chairing the United Nation's High Level Panel (HLP) of Eminent Persons.

Appointed by UN Secretary-General Ban Ki-moon, the HLP consists of 26 prominent figures including former heads of government and representatives of civil society, youth, academia and the private sector.

To successfully perform this important and noble job, Yudhoyono is assisted by a national committee, which was recently formed through Presidential Decree No. 29/2012 and is chaired by Kuntoro Mangkusubroto, the head of the Presidential Working Unit for Supervision and Management of Development (UKP4).

One of the President's tasks is to lead the HLP in advising the UN Secretary-General on the vision and shape of a post-2015 development agenda, responding to the global challenges of the 21st century and building upon the Millennium Development Goals (MDGs), with an aim of eliminating poverty.

Having been agreed upon by all 193 UN member states and at least 23 international organizations to achieve by the year 2015, the MDGs consist of eight global development goals. They are: 1) eradicate extreme poverty and hunger; 2) achieve universal primary education; 3) promote gender equality and empower women; 4) reduce child mortality rates; 5) improve maternal health; 6) combat HIV/AIDS, malaria, and other diseases; 7) ensure environmental sustainability; and 8) develop a global partnership for development.

Nearing the deadline set for MDGs accomplishment in 2015, the panel therefore is tasked to advise the UN Secretary-General on building and sustaining broader political consensus on an ambitious yet achievable post-2015 sustainable development agenda around three pillars: economic growth, social equity and environmental sustainability.

Learning from the uneven progress toward reaching the MDGs and criticisms from development practitioners, experts and civil society, the HLP should rectify the drawbacks and deficiencies of the MDGs implementation in 2001-2011. According to the 2011 UN MDG Progress Report, some countries have reached many of the goals, while others have failed or have struggled to achieve any. Progress toward some goals and targets has disappointedly been stagnant and even regressed. For example, the proportion of hungry people (goal 1) has increased by 16 percent since 2000/2002.

Criticisms that beg the HLP's response can be classified into two categories (Fukuda-Parr, 2012). First, those that relate to the composition of the goals, targets and indicators of the MDGs. Under this category, the critics have spoken out against poorly designed development goals; the narrow composition and dimensions of development; a lack of attention to equality, important norms and principles, in particular falling short of human rights standards; an unbalanced international political economy; and a distortion of national priorities.

Second, critics have raised concerns about the process to formulate and implement the MDGs. These criticisms include the lack of broad consultation in formulation; the national adaptability of the global goals; criteria for success and methodology of measuring progress; and an aid-centric process.

But why have some of the MDGs not or unsatisfactorily been achieved? First, those goals are unrealistic and unattainable. They do not truly represent the interest or policy priorities of some countries. Moreover, these countries lack strong incentives, and thus lack the political commitment to achieve those goals. Thus, there is no effective "reward and punishment" mechanism to push states to reach these goals.

Furthermore, there is no global, effective and integrated system for monitoring and evaluating progress. More importantly, developed countries do not genuinely and fully support and help developing countries, in particular least developed countries to attain these goals. And lastly, "external" factors, such as the recent economic crisis in Europe, have badly affected the financial and economic capacities of some countries to realize the MDGs.

Therefore, in recommending sustainable, inclusive and equitable development goals (SIEDGs) and an agenda to the Secretary-General, the HLP should learn from the drawbacks in the formulation and implementation of the MDGs. SIEDGs must be based on both the common problems faced by all states and those specific to developing countries. Thus, the goals are split into two levels: common and specific SIEDGs.

Developed and developing countries face new and common challenges in the 21st century. Some of these challenges are climate change with all its destructive effects; food, energy, and water crises; poverty; corruption; human trafficking; drug abuse; environmental degradation; unsustainable use of resources and development; terrorism and extremism; unemployment; unilateralism and the use of force in resolving disputes; HIV/AIDS and communicable diseases; and global capitalist economy which is prone to economic crisis.

However, developing countries confront new challenges specific to them, such as population booms, limited resources and capacity, debt crises, a lack of technology, human rights abuses, poor access to justice and health, high child mortality rates, extreme hunger, low education levels and low trade competitiveness.

Importantly, the HLP should focus more on overcoming the acute problem of global corruption and bad governance. To some extent corruption, as many researchers have found, is primarily responsible for poverty, deforestation and environmental degradation, economic injustice, poor access to healthcare, social injustice, human rights abuses and even wars.

Instead of achieving the goals in 15 years, all the goals of the SIEDGs should be realized by all countries in 20 years (2015 – 2035). However, some goals can be fully achieved before that time. The progress and performance of countries in attaining the SIEDGs should fairly be evaluated and judged according to their capacity and specific circumstances. The UN and developed states should establish a "global SIEDG fund" to reward developing countries that have performed well in realizing

(sumber : thejakartapost.com)

Aussie ambassador visits health facilities in East Nusa Tenggara

Australian Ambassador to Indonesia Greg Moriarty visited a number of health facilities in East Nusa Tenggara (NTT) that were established with financial aid from the Australian government to contribute toward improving people's health in the province.

Upon his arrival on Friday, Moriarty and his entourage made a field tour of public health centers in Pasir Panjang and Naikoten II, Kupang, which were a few of the 97 health clinics and public health centers under the programs funded by AusAid.

He said he was proud of the aid programs because of the increasing number of pregnant women giving birth at the public health centers and maternal clinics, which was reflected in a decreasing maternal mortality rate in the province.

"Australia is committed to working with the government of Indonesia in East Nusa Tenggara as it is a province with some of Indonesia's highest rates of poverty. It is good to see the valuable work being undertaken to help reduce NTT's high incidence of maternal mortality. Since 2008, there has been a 20 percent increase in women giving birth in safer health facilities rather than at home," said Ambassador Moriarty.

He explained that the Australian government has also provided training programs for health wokers on emergency obstetrics and neonatal care, and supported the campaign program for pregnant women to give birth at health facilities.

The ambassador also visited the South Timor Tengah hospital in Soe, one of the region's 11 district hospitals participating in the AusAID-funded Sister Hospital program.

"This hospital is now better equipped to deal with emergency obstetrics and neonatal services, thanks to training provided by medical specialists from a tertiary hospital in Surabaya. The sister hospital program is clearly effective and achieving results," said the ambassador.

In his field tour to Kefamenanu, North Timor Tengah regency, the Ambassador is opening a resource center built under AusAID's decentralization program.

"This center will serve as an information and data repository for the district. Staff at the center will provide information to public servants, civil society organizations and members of the public, to help with better planning and allocation of local resources," he said.

The ambasador also held a meeting with farmers in Oenaen village to see the Australian government's aid program in the agriculture sector in the regency. Through AusAID's rural program, farmers are being supported to increase productivity and yields.

Moriarty also said Australia would continue negotiating with the Indonesian government to seek a solution to the marine pollution on the Timor Sea, caused by the recent explosion at the oil field in Montara.

(Sumber : thejakartapost.com)

Thailand vaccine trial edges closer to dengue vaccine

bangkok - Scientists have edged closer to a dengue vaccine following trials in Thailand, where dengue fever is endemic, that have shown a vaccine candidate to be safe and effective, although more evidence is needed to prove its effectiveness.

The results of the clinical phase II trial, showing the vaccine to be 30 per cent effective in protecting from dengue, were published in The Lancet last week (11 September). The vaccine CYD-TDV, which was developed by the drug company Sanofi Pasteur, has been tested on 4,000 children aged four to 11 from 57 schools in Thailand's Muang District.

Dengue fever is the world's most widespread mosquito-borne viral disease with around half of the global population at risk. There is no vaccine to protect against it, although there are several being developed.

It is difficult to develop an effective vaccine because dengue fever is caused by four different strains of virus — known as DENV 1, 2, 3 and 4. The challenge is to develop a vaccine that can protect against all types of dengue virus.

"The results of this trial show that the vaccine can protect against dengue fever caused by three virus types [DENV 1, 3 and 4]," said Pascal Barollier, a Sanofi Pasteur spokesperson. "The vaccine was well tolerated and safe, with no serious effects on those who received it."

But scientists not involved with the study say there is not enough data to prove the vaccine's effectiveness against severe dengue disease, and urged for further, larger trials.

Scott Halstead, a physician at the International Vaccine Institute in Seoul, Republic of Korea, said the result was both "surprising and disappointing", pointing out that the vaccine does not protect against DENV 2, "the most common type in Thailand".

He said it is too early to draw any conclusions about the vaccine's safety.

Sutee Yoksan, director of the Center for Vaccine Development at Mahidol University in Thailand, shared Halstead's concerns, and called for further investigations.

According to Barollier, phase III clinical studies involving 31,000 children and adolescents are ongoing in Latin America (Brazil, Columbia, Honduras, Mexico and Puerto Rico) and in five Asian countries (Indonesia, Malaysia, the Philippines, Thailand and Vietnam) where dengue is endemic.

These trial results are expected in 2014. If successful the vaccine could be available in 2015 in countries where dengue is a public health priority.


Health Ministry Wants Rp 1.8 Billion to Kill Cockroaches

The Health Ministry is under fire for allocating Rp 1.8 billion ($190,000) to kill cockroaches and flies in its own offices, with one lawmaker wondering aloud whether the ministry staff is aware of proper sanitary habits.

Poempida Hidayatullah, a member of House of Representatives Commission IX, overseeing financial affairs, said that he had no strident objections to the plan, but still found it curious that the Health Ministry would allocate funds for it.

He added that one obvious key to a pest-free environment was preventative cleaning.

"I'm not going to make a fuss about the program to extinguish flies and cockroaches," Poempida said on the sidelines of a meeting with the Health Ministry in Jakarta on Monday. "I see the benefit that it will make the Health Ministry office more hygienic. But is this because they are filthy?

"I'm just going to think positively. Maybe the cockroaches and the flies appeared because the health program failed."

But the $190,000 plan to kill insects wasn't the only Health Ministry budget item that raised eyebrows on Monday.

Poempida also voiced suspicions over a plan to spend Rp 80 billion for certification for 2,500 health lecturers.

That would mean a budget expenditure of over Rp 30 million per certification, an amount the lawmaker said was absurd.

"Rp 30 million for certification training doesn't make sense. It should only cost Rp 2 million to Rp 3 million. That amount just doesn't make any sense," Poempida said.

Rieke Diah Pitaloka, another member of Commission IX, added her own suspicions, singling out a vague budget request for an unnamed number of vehicles for the ministry.

"There was a budget request for a vehicle worth Rp 700 million per unit, which is still not clear yet," Rieke said.

She also harshly criticized the ministry's plan to allocate more money for bureaucracy than for public health services in next year's state budget.

Rieke, a former actress turned outspoken politician, said that the ministry allocated about 49 percent of their total budget, or Rp 15.3 trillion, for public health services, and almost 51 percent, or Rp 15.8 trillion, for bureaucracy.

Out of the 51 percent allocated for bureaucracy, the ministry is allocating 22.7 percent for office maintenance and supplies and 17 percent for monitoring and evaluation activities.

"What good does it do if the state budget is used for bureaucratic needs?" Rieke said. "We should focus more of the budget on public health services."

In response to the criticism, Health Minister Nafsiah Mboi argued that the bureaucratic expenditures included salaries for vital medical staff, such as paramedics.

"This doesn't mean that bureaucracy is more important, but this is for the paramedics. Who's going to serve the public if no paramedics are available? We need many paramedics."

Nafsiah claimed that she had reduced office costs and that most of the bureaucratic budget would be used to assist paramedics on a regional level.

"You must look at the details of the budget," she said. "In this meeting we are talking about the macro aspects. Please discuss the micro aspects with my staff from Echelon I," she said, referring to top-level ministry officials.

Also on Monday, the Indonesian Forum for Budget Transparency (Fitra) criticized the Rp 23 trillion allocated in next year's draft budget for official travel expenses for ministries and government institutions.

A Fitra spokesperson said the amount was too high and prone to graft.

Finance Minister Agus Martowardojo said he is continuing to evaluate the amount budgeted for official travel expenses.


Health Ministry: 175 1Malaysia clinics by end of the year

Kuala Lumpur - The Health Ministry plans to have 175 1Malaysia clinics by year-end due to the high demand, said Minister Datuk Seri Liow Tiong Lai.

"The clinics have benefited some five million patients so far. The response has been very encouraging.

"There are currently 119 1Malaysia clinics in operation nationwide while 56 more are in various stages of implementation," he said at the launch of the 1Malaysia clinic at the Danau Kota flats here yesterday.

Liow said they planned to expand the clinics' services to include healthcare for mothers and children beginning next year.

The 1Malaysia clinics, he said, would make it easier for patients to seek treatment as they were open from 10am to 10pm and located near residences.

Patients, he said, could seek treatment at the community-based clinics but needed to go to a hospital for serious ailments.

The clinics offer treatment for minor ailments such as cough, flu and fever, basic dressings, sugar and urine tests as well as health advice, among others.

Liow later attended the Hari Raya open house organised by Wangsa Maju MCA division chief Datuk Yew Teong Look's service centre. Yew was formerly the Wangsa Maju MP.


Health, education ministries launch online course for field epidemiologists

The Health Ministry has launched an online distance-learning course for field epidemiologists to help them improve their knowledge about epidemiological investigations, which might be useful when dealing with unexpected public health crises.

The 2012 Field Epidemiologist Training Program (PAEL) offers participants a unique online training methodology in which they can study from anywhere in the country.

"Many health workers have limited chances to attend training courses as they live in remote areas, precisely those places that are classified as areas with serious health problems," Sulistiono, the Health Ministry's human resources, learning and training center head, said on Friday.

Field epidemiologists have the responsibility of investigating unexpected health problems that need immediate intervention.

Some 140 epidemiology field assistants are currently attending the online PAEL pilot program in seven provinces: Central Java, East Java, Jakarta, North Sumatra, South Sulawesi, South Sumatra and West Java.

The program, developed by the ministry in collaboration with the Education and Culture Ministry's Information and Communications Technology Center (Pustekkom), began on Sept.11 and will run for the next 31 days.

Sulistiono hopes that such trainings would be developed further in the future. "The e-learning can be done from home, which means we can be more efficient in our spending," he said.


Study of U.S. Health Care System Finds Both Waste and Opportunity to Improve

WASHINGTON — The American medical system squanders 30 cents of every dollar spent on health care, according to new calculations by the respected Institute of Medicine. But in all that waste and misuse, policy experts and economists see a significant opportunity — a way to curb runaway health spending, to improve medical outcomes and even to put the economy on sounder footing.

"Everybody from Paul Krugman to Paul Ryan agrees it is essential to restrain costs," said Dr. Mark D. Smith, the president of the California HealthCare Foundation and the chairman of the committee that wrote the report, referring to the liberal economist and Op-Ed columnist for The New York Times, and the conservative Wisconsin congressman who is Mitt Romney's vice-presidential running mate. "The health care industry agrees, too."

The Institute of Medicine report — its research led by 18 best-of-class clinicians, policy experts and business leaders — details how the American medical system wastes an estimated $750 billion a year while failing to deliver reliable, top-notch care. That is roughly equivalent to the annual cost of health coverage for 150 million workers, or the budget of the Defense Department, or the 2008 bank bailout.

The institute's analysis of 2009 data shows $210 billion spent on unnecessary services, like repeated tests, and $130 billion spent on inefficiently delivered services, like a scan performed in a hospital rather than an outpatient center.

It also shows the health care system wasting $75 billion a year on fraud, $55 billion on missed prevention opportunities and a whopping $190 billion on paperwork and unnecessary administrative costs. The Institute of Medicine is an independent adviser to the government and the public, and part of the National Academy of Sciences.

The report depicts a system that saves lives in miraculous fashion, but is also expensive and outmoded and in some cases downright Kafkaesque.

"If banking were like health care, automated teller machine transactions would take not seconds but perhaps days or longer as a result of unavailable or misplaced records," the report said. "If home building were like health care, carpenters, electricians and plumbers each would work with different blueprints, with very little coordination."

Along with the squandered money there is a human toll, the report said, as medical errors and inefficiencies mean that doctors fail to deliver the best and most timely care to patients.

"If the care in every state were of the quality delivered by the highest-performing state, an estimated 75,000 fewer deaths would have occurred across the country in 2005," the report said.

But the report — and independent health care experts and economists analyzing it — identified an opportunity in that $750 billion of wasted health spending. If hospitals, doctors and insurers could wring even a fraction of that money out, it would help to bend the so-called cost curve of runaway health inflation while improving patient outcomes.

The point of the report is that "Americans should expect to get and should demand to get better value for their health care dollar," Dr. Smith said.

"That money is not only not buying anything," said David Cutler, the Harvard health economist. "It is actually a sign of poor care. A lot of cost reductions, if we do them the right way, would mean improved health, not worse health."

Professor Cutler gave as an example rules to make sure that doctors do not perform inductions for otherwise healthy pregnant women before 39 weeks of gestation. It would both save money and improve health outcomes by reducing the rate of Caesarean sections, he said.

The report gives recommendations intended to reduce spending and improve care: ensuring doctors work in teams and share information; making prices and costs transparent to consumers; rewarding doctors for outcomes, not procedures; ensuring all doctors use the best-tested practices, and identifying and correcting errors among them.

The report also detailed instances of health care providers offering such smarter care: hospitals preventing re-hospitalizations, upgrading their records systems and cutting out ineffective therapies, for example.

Some health economists and policy experts believe that political changes and financial pressure have already spurred insurers and health care providers to start squeezing out costs, contributing to the slowdown in health spending growth seen in the past few years.

"We're starting to see some very early results," said Wendy Everett, the president of NEHI, a health care research group based in Cambridge, Mass.

She said she expected to see more and more adoption of best practices in the next few years, spurred by President Obama's Affordable Care Act, other changes to Medicare and Medicaid and a recognition among doctors and insurers that the current trajectory of health care spending is unsustainable.

"This train's coming much faster than we thought," Ms. Everett said. She guessed that within a decade providers being paid for the quality, not quantity, of care would be "the norm."