China’s latest revolution: Basic health care for all

BEIJING: In a little over three years, China has managed to extend basic health-care access to more than 95 percent of its 1.35 billion population.

"This was mainly done by extending health insurance coverage and improving access to reformed and reinforced health-care facilities and services nationwide", said Aidi Hu, a Senior social security expert from China, who works for the ILO.

The aim of the reform – which had a total cost of 850 billion Chinese Yuan (CNY) or about 133.5 billion US-dollars – was to achieve universal health-care coverage for the entire population by 2020. However, the scope and pace of changes seem more akin to a revolution than a reform.

Only a decade back, health insurance coverage was mainly for those working in urban areas under a formal employer-employee relationship. In 2003 and again in 2007, the government launched two schemes to extend coverage to rural populations and to non-working urban residents. First, the health-care budget was increased by 30 percent each year between 2008 and 2011. A large proportion of these resources were invested in staff training and enhancement of local health services.

The government also invested CNY 63 billion in rural areas to support the construction or improvement of over 2,200 county-level hospitals, some 6,200 central township clinics and 25,000 village clinics. CNY 4.15 billion was also invested in urban areas to support the construction and improvement of almost 2,400 community health-care centers.

The government also provided technical assistance to 127 training centers where 36, 000 health-care staff received training as general practitioners. More than 10,000 medical students were admitted by various medical colleges for training – free of charge. These students went on to work in township clinics in the less-developed central and western regions of China.

In addition, basic medicines are now sold at the same price across the country.This practice prevents hospitals from overcharging its patients. Pharmaceutical companies were also asked to start bidding for contracts, which led to a 30 percent reduction in the price of basic medicines.

Helping the "Three No" people

The new system is aimed especially at people with no resources, no ability to work and no one to support them (the so-called "Three No" people). It also entitles them to equal access to basic health care.

The old system was unaffordable for most rural and non-working urban residents, as well as for old and disabled people. Local governments now fully cover the individual health-insurance contributions of the latter group.

The rapid extension of health insurance in China can also be attributed to the 2010 Social Insurance Law, to which the ILO provided technical assistance.

"Due to the extension of health insurance in the most populous country in the world, the global social security gap has been significantly reduced", said Hu.

"The Chinese experience shows that political will and financial commitments play a key role in extending health insurance schemes to vulnerable social groups. It can serve as an example for good practice to other countries in a similar situation", concluded Hu.

But the ILO expert cautions that "some insured people – despite receiving government subsidies – are still unable to benefit from coverage as they still bear an important part of the costs for medical treatment and have limited access to good-quality health services. This is particularly true for the rural areas, where there are only 1.32 health workers per 1,000 people, compared to more than 8 and 20 per 1,000 in Brazil and Switzerland, respectively".

Another challenge is China's rapidly aging population. The share of the population aged 65 years and older will increase from 8 percent today (about 100 million) to about 14 percent in 2025 (some 200 million). The number of frail and sick elderly people will increase accordingly and with it, the costs for the health insurance system.

A new partnership agreement between the ILO and China was signed in June 2012. Under the agreement, the ILO and China will work more closely together. This partnership will also extend to the field of social insurance, thus contributing to the extension of social security worldwide. (

WHO Warns About Drug-Resistant TB Outbreak

The World Health Organization warned people on Thursday that a drug-resistant TB outbreak threatens worldwide nations. According to the Associated Press the study was carried out on more than eight nations and results have shown that many cases of TB were resistant to first and second line medicines.

Humanity could be in danger of dealing with another tuberculosis epidemic, according to the findings reported by a new study published in "The Lancet". Scientists have gathered 1,278 patients from several countries, including Estonia, Latvia, Peru, the Philippines, Russia, South Africa, South Korea, and Thailand. Respondents were carefully studied from 2005 to 2008 while they were given various treatments. Scientists have thus, discovered that patients were suffering from highly resistant TB cases whose occurrence could increase in the future unless officials do something to prevent them.

The study's main goal was to identify the factors that have contributed to the resistance of the disease. In addition, scientists tried to find new methods and treatments that could help cure patients with multi-drug resistant TB before the illness becomes a worldwide epidemic.

Patients who were included in the study reported high levels of XDR-TB. Their affection did not respond to the first line treatment that was given to them, namely, isoniazid and rifampin, but also to the second-line fluoroquinolone drugs. TB patients were also treated with injectable drugs, such as, amikacin, capreomycin, or kanamycin, but their state did not improve at all.

The most resistant cases of TB were the ones of the patients who underwent medical treatment without curing completely. Socioeconomic factors, such as, unemployment, alcohol abuse, and smoking represent the other reasons why patients developed highly resistant cases of tuberculosis. In researchers' opinion, these factors should be taken into account if health organizations want to prevent this disease from spreading towards other unaffected areas. As in the case of the less resistant TB, a correct hygiene is considered essential to prevent similar epidemics in the future. (

Yogyakarta to Host Health Conference

Yogyakarta is preparing to host a meeting of health ministers from 11 Asian countries who will discuss the most important health issues facing the region.

Convened by the World Health Organization, the 30th Meeting of Health Ministers of the Region will run Sept. 4-7. The forum will be a chance to exchange political, social and economic strategies from the point of view of the health sector.

"There will be many issues discussed during the event, especially the control of diseases, contagious or not," said Tjandra Yoga Aditama, the Health Ministry's director general for disease control and environmental health.

He said Indonesia exerted a major influence over the region's health sector, with other countries in Southeast Asia taking note and following its example. "Indonesia's voice is influential because we are the country with the largest population in SEARO," Tjandra said, referring to the Southeast Asian Regional Office of the WHO.

Other countries grouped in SEARO are Bangladesh, Bhutan, East Timor, India, Maldives, Myanmar, Nepal, North Korea, Sri Lanka and Thailand.

Some of the key issues expected to be discussed at the gathering are the eradication of polio, preparation for an influenza pandemic and routine immunizations.

The conference will also focus on regional health issues, and the strengthening of policies to overcome non-contagious diseases, which can still be deadly.

Indonesia continues to face many health problems, including a paltry 83 percent coverage for basic immunizations.

Tjandra said 100 percent coverage would be difficult to achieve because of the country's difficult geography as well as the rise of anti-immunization campaigns by groups pushing different agendas.

In 2011, 11.5 million children in the country were immunized against measles as part of an additional, non-routine immunization campaign.

The Health Ministry has set a target to have 100 percent of the population immunized against polio, measles, hepatitis B, tetanus and tuberculosis by 2014.

Indonesia is also struggling to overcome avian influenza, or bird flu.

Through the middle of August, 191 people in Indonesia have tested positive for avian influenza since 2005, with 159 deaths. These figures are the highest in the world where at least 300 people have died from the disease since 2005.

Another pressing health issue is the rise of non-contagious diseases like cancer, heart disease and diabetes, which now account for the largest number of deaths in Indonesia. The death rate from non-contagious diseases has risen from 41.7 percent in 1995 to 49.9 percent in 2001 and 59.5 percent in 2007.

Stroke remains the top killer, accounting for 15.4 percent of deaths, followed by hypertension, diabetes, cancer and chronic obstructive lung disease.

Deaths from these non-contagious disease are seen both in urban and rural areas around the country. (

Singapore, Malaysia, Indonesia to share data about dengue fever trends

Singapore - Researchers from Singapore, Malaysia and Indonesia are studying dengue fever trends in their latest bid to fight the disease.

The trends will help researchers track the viruses and understand how they spread in the region.

This was announced on Tuesday at the launch of a portal called UNITEDengue, which stands for United in Tackling Epidemic Dengue.

The portal allows the three countries to share surveillance information about the disease.

Other types of information to be shared on the portal include weekly updates of dengue cases, as well as prevention strategies.

The initiative was launched at the opening ceremony of the Third Asia-Pacific Dengue Workshop in Singapore.

One of the aims of the initiative is to get timely updates of the dengue situation in the region.

Latest data shows Malaysia is seeing a downward trend of dengue fever, after a peak early in the year.

Singapore is in the high-risk season, between July and September.

Some 115 cases had been reported, in the week beginning August 12. In the same period last year, there were 131 cases.

Director of the Environmental Health Institute Associate Professor Ng Lee Ching says controlling dengue is a cross-border challenge.

With this portal, Dr Ng says authorities can then alert each other if there are outbreaks in one region.

Dr Ng says when looking at data from Malaysia, it would be more accurate to analyse the data from each state rather than the national figure. That way, researchers are likely to find more correlation between the Malaysian states and Singapore.

Singapore shows the highest correlation with the Malaysian states of Johor and Penang.

For example, if there is a spike of dengue cases in Johor, this would also be seen in Singapore.

While researchers are not surprised by the correlation with Johor, they were surprised by the link with Penang given its geographic distance from Singapore.

The three countries are hoping to rope in more countries, to share their information on fighting dengue. (

Global pharmaceutical competitiveness

Pre-qualification hurdles to cross

Over the years, the nation's pharmaceutical industry has remained a weak competitor when compared with international firms, following its inability to manufacture drugs that meet international standards. This inability to compete in the global market is hinged on the fact that, as of today, the nation's industry cannot withstand the drugs armada from China and India which have better cost advantages.

The Indian pharmaceutical manufacturers supply 70 percent of drugs consumed locally and also export. Between 2009 and 2010, the industry, made up of thousands of large and small firms, exported $9.1 billion worth of drugs and made a turnover of $21.7 billion.

According to PricewaterhouseCoopers (PWC) in 2010, India joined among the league of top 10 global pharmaceuticals markets in terms of sales by 2020 with value reaching $50 billion. While the domestic market was worth $12.26 billion, sale of all types of medicines in the country is expected to reach around $19.22 billion by 2012.

Globally, India's pharmaceutical industry is ranked 4th and 13th in terms of volume and value. Indian firms manufacture at far lower costs than their counterparts in developed countries. This is one half of its success as India spends $23 billion on Research and Development (R&D), has 160,348 researchers, 40,711 research articles, and 1,234 patents.

With the pharmaceutical industry seen as one of the most valuable economic segments of the global economy, the pharmaceutical industry is considered to have installed capacity that only caters for about 50 to 75 percent of the nation's drug needs.

Annually, millions of patients in resource-limited countries receive life-saving medicines that are purchased by or through international procurement agencies such as World Health Organisation (WHO), United Nations Children Fund (UNICEF), United Nations Population Fund (UNFPA), UNITAID and the Global Fund to Fight AIDS, TB and Malaria.

With WHO Prequalification of Medicines Programme ensuring that selected medicines supplied by these agencies meet international standards of quality, safety and efficacy, the WHO and the Global Fund spends over N20 billion annually in procuring drugs for malaria, TB and AIDS intervention programmes in Nigeria from especially India and Brazil because no pharmaceutical firm in Nigeria is pre-qualified by WHO.

WHO pre-qualification is a prerequisite for any company that wants the WHO and other international agencies to buy their drugs through bulk purchase for distribution for health intervention programmes across the globe.

Prior to prequalification of drugs by WHO, manufacturers apply to WHO to have a product evaluated, providing comprehensive information about the product's quality, safety, and efficacy.

While WHO inspection team visits the manufacturing sites of both the finished pharmaceutical product and its active pharmaceutical ingredients to verify that they comply with WHO good manufacturing practice (GMP), the team, which includes an inspector from a 'stringent regulatory authority' also verify that any contract research organization that conducted any studies relating to the product complied with good clinical and laboratory practices.

When the comprehensive scientific assessment and necessary inspections indicate that the product meets international standards for quality, safety and efficacy, the product is added to the WHO list of prequalified medicinal products.

Most pharmaceutical manufacturers in India, China, United States of America, Germany, etc, produce pharmaceutical raw materials, vaccines, consumables and finished products and in turn export them to boost their foreign earnings.

Surprisingly, pharmaceutical firms in Nigeria are not currently in a position to participate in international tenders for medicines against the three pandemics that require World Health Organisation's (WHO) prequalification.

This has been identified as a major constraint on the local supply of medicines, especially anti-retroviral (ARVs), anti-malarial and anti-tuberculosis agents.

With over 100 pharmaceutical manufacturers in Nigeria, only five local drug manufacturers- -Evans Pharmaceuticals, SWIPHA, CHI Pharmaceuticals, May and Baker and Fidson Healthcare Plc- are currently modifying their production processes with an aim of complying with the WHO prequalification requirements.

In Africa, only South Africa, Morocco and Uganda have prequalified drug manufacturing companies and the right to sell pharmaceutical drugs to other countries.

The experience of East Asian newly industrialised countries with successful manufacturing attests to the fact that efficiency and productivity growth in the manufacturing sector is the key to promoting competitiveness and growth of the industrial sector and the economy as a whole.

Expert view

Speaking with BusinessDay, Azubike Okwor, President, Pharmaceutical Society of Nigeria (PSN), revealed that life-saving medicines are purchased annually by or through international procurement agencies for health intervention programmes globally from pharmaceutical firms that meet internationally standards of quality, safety and efficacy, a situation that has deprived Nigeria from entering into international bidding process for pharmaceutical products, particularly from WHO.

While noting that about five pharmaceutical firms are striving to comply with WHO prequalification requirements, Okwor disclosed that WHO prequalification will help the nation become self-sufficient in the manufacture of essential medicines.

"This would obviously have multiplier effects on the Nigerian economy as it would lead to the creation of thousands of jobs and more foreign exchange earnings for the country. This in turn would reduce the plethora of challenges confronting the pharmaceutical sector such as counterfeiting of drugs and continued dependency on the importation of drugs and pharmaceutical inputs for drug production," Okwor noted.

Lending his view, Nnamdi Okafor, Managing Director, May and Baker Plc, disclosed that the WHO qualification helps to upgrade facilities to global standard. While stating that another leg of it is this huge fund that comes with it, Okafor stated that the fund is meant to help Nigeria take care of certain diseases like HIV/AIDS, Tuberculosis, and malaria.

"When this funding comes in, Nigeria is expected to have counterpart funding in it. We are told that unless we have WHO prequalification, we cannot participate in it. This disqualifies all Nigerian companies from participation. What that does to us is that other factories in other parts of the world are producing products that are demanded globally.

"In Nigeria, most factories are producing at less than 45 percent capacity and cannot meet the pre-qualification. For Nigerian companies to do this, government assistance is needed to achieve this feat," Okafor hinted.

The Indian experience

The emergence of Indian pharmaceutical industry on the global landscape as a strong generics player was due to 1970 Indian Patents Act which allowed only process patents in pharmaceutical products.

This move also kept the cost of medicines at affordable levels by enabling domestic pharmaceutical firms build technical expertise in reverse engineering of existing medicines by modifying the manufacturing process and, thus, becoming efficient producers of generic drugs.

Although India shifted to the product patent regime in 2005, the capabilities developed during the past two decades became a competitive advantage for the Indian pharmaceutical industry in the 1990s when rising healthcare costs in many developed countries forced them to seek the cheaper generic drug option.

The Indian pharmaceutical industry was able to exploit the enormous generic opportunity that was spawned. Interestingly, the share of Indian pharmaceutical companies in the total pie of approvals for generic drugs (Abbreviated New Drug Applications (ANDA) approvals in the U.S.), has risen steadily.

More than a third of ANDA approvals were by Indian firms. As a consequence, formulation exports from India, essentially generic drugs, have grown at 21 percent compounded annual growth rate (CAGR) between 2005-06 and 2010-11.

With about $150 billion worth of drugs set to lose patent exclusivity between 2010 and 2015, Crisil Research expects the growth momentum in exports to continue over the next five years, with exports growing at 14-16 per cent CAGR.

In the near-term, the generic opportunity continues to lure more companies. With competition intensifying, generic drugs will see greater price erosion. Along with higher competition, the global generic market is set to face another hurdle in the longer term.

Already, R&D productivity of large global pharmaceutical players (innovators) has slowed considerably over the past few years. R&D productivity, a function of cost of new drug development and returns from those new drugs, is of critical importance as global players invest heavily in R&D (about 20 percent of revenues).

Furthermore, the Indian bio-pharmaceutical industry is in its emerging stage and is sized at about $1.4 billion as of 2010-11. The Indian bio-pharmaceutical players largely market vaccines and are yet to make inroads into U.S. and Europe.

Of importance is the fact that the low cost of manufacturing renders India as an attractive destination for contract research, and the availability of a large patient pool makes it appealing for clinical trials, which contributes the most, in terms of revenue, to the contract research segment.

With limited experience and high costs associated with bringing a drug to the market, Indian players have traditionally shied away from drug discovery, or in a few cases, out-licensed molecules to multinational companies at early stage of development.

At present, only a handful of Indian companies (leading the pack are: Piramal Life Sciences, Glenmark and Sun Pharma) are engaged in new drug research. Amid slower growth in the generics space, large Indian players look to enhance their focus in this area. The high-risk high-return field of new drug research holds tremendous potential for Indian players.

Competing globally

Nigeria's pharmaceutical industry has a long and arduous way to go. Experts believe that without clusters (centres of excellence) and well-funded research laboratories that churn patents protected by law, the industry's global ambition is limited. If these enablers are put in place, it could induce local and foreign investment and partnership with foreign firms.

While some Nigerian Pharmaceutical firms are modifying their production processes with the aim of complying with the WHO prequalification requirements, Ola Ijimakin

General Manager, Marketing, FIdson Healthcare Plc, revealed that the company (FIdson Healthcare Plc) has applied for pre-qualification with their facility been inspected by officials from the WHO.

"We are among the five companies selected by the WHO team that they intend to work with to secure the certification. We are putting up a completely new facility that will come on stream in 2013. This facility is designed and built to conform to the latest WHO-GMP standards," Ijimakin revealed.

For Nnamdi Okafor, Managing Director, May and Baker Plc, when a pharmaceutical firm wants to export to countries in Asia and Europe, the pharmaceutical firm need to export products that meet WHO prequalification exercise.

"The first thing we want to do is get our GMP standard so that we can say that our products compare with the rest in the world so that we should be able to export them to other parts of Africa, Asian and even Europe. WHO prequalification process is a long one which could take a year to two to get prequalified.

"From the WHO report, a representative from Who was in Nigeria recently to present a report to Minister of Health Onyebuchi Chukwu on the level of preparedness of Nigerian companies. He was quite positive that within the next one to one and half year, the first product will prequalify Nigeria and we look forward to being one of the companies whose products will be prequalified," Okafor concluded.

Paul Orhii, director general, NAFDAC, believes that once WHO upgrade pharmaceutical facilities coupled with the pharmaceutical intervention fund, Nigeria drug firms can then upgrade to a level where it would be par with other manufacturing companies in the world.

"We believe this would not only ensure that locally manufactured pharmaceutical products in Nigeria gain international acceptance. The nation can then request that drugs donated to Nigeria are purchased locally. This feat would help reduce the challenges confronting the pharmaceutical sector, such as low capacity utilisation, high production cost, drug counterfeiting, and continued dependency on the importation of drugs and pharmaceutical inputs for drug production," Orhii concluded. (


Tobacco on pace to kill 1 billion people this century

The World Health Organization is warning that tobacco could kill a billion people around the world in this century.

The Global Adult Tobacco Survey noted that nearly half of all men and more than one in 10 women use tobacco in many developing countries, reported. According to the study, women are also starting to smoke at an earlier age.

The authors of the study told Time that the numbers call for urgent changes in tobacco policy and regulation in developing nations.

Gary Giovino, of the School of Public Health and Health Professions, told Time, "Our data reflect industry efforts to promote tobacco use. These include marketing and mass media campaigns by companies that make smoking seem glamorous, especially for women. The industry's marketing efforts also equate tobacco use with Western themes, such as freedom and gender equality."

Egypt is one country where researchers said they were seeing the largest increase in smoking. Edouard Tursan D'Espaignet, of WHO's tobacco control program, told CNN that the increase is partially due to the revolution.

CNN noted that government regulations limiting smoking fell apart after Hosni Mubarak's regime was ousted last year. Tursan D'Espaignet added that "the tobacco industry walked in very, very aggressively" to market its product amid the chaos. "We are hearing things like 'Smoking is a way to show you're free from the previous regime,'" he said.

According to the Atlantic, manufactured cigarettes are the most widely used form of tobacco in the countries surveyed by the GATS. Cigarettes accounted for 82 percent of tobacco consumption. The study's authors noted, "These products are technologically designed to mask harshness, provide particular taste sensations, and increase nicotine delivery."

There are still glimmers of hope in the fight against smoking. Earlier this year GlobalPost reported that a CDC study showed that cigarette smoking declined by 2.5 percent in the US from 2010.

The GATS study was funded by the Bill and Melinda Gates foundation, with additional funding from Bloomberg Philanthropies.

According to CNN, Bloomberg Philanthropies says that in 2007, it supported the WHO's efforts "to package and promote six proven policies to reduce tobacco use worldwide." It added that since then, "21 countries have passed 100 percent smoke-free laws, the percentage of people protected from second-hand smoke has increased 400%, and almost four billion people worldwide are now protected by at least one of the six proven tobacco control policies." (

We should urgently integrate TB-HIV care

Tuberculosis (TB) is responsible for 60 percent of the deaths among persons living with HIV/AIDS.

Given this relationship, the World Health Organization (WHO) recommends that care services are integrated between the two conditions. Uganda has registered some progress but the technocrats want the success rate at 100 percent. Kakaire Ayub Kirunda spoke to Dr Anna Nakanwagi Mukwaya, the Chief of Party in Uganda for the International Union against Tuberculosis and Lung Disease (The Union) to put things into perspective.

Why is the integration of TB-HIV care such a big deal these days?

HIV is the leading risk factor for the development of tuberculosis disease. At the same time, tuberculosis is the leading cause of death among people living with HIV. In a country like Uganda where the TB burden is so huge (the community has with TB germs in the air) and HIV/AIDS that is depressing the immunity of persons with HIV, then chances of picking TB are high.

That is why you see this one AIDS patient with TB but usually the TB came because of the condition of HIV which affected their immunity. We can no longer have a situation where a patient comes into a clinic, gets treatment, and we do not look out for TB. It is going to kill them. Whenever health workers see HIV/AIDS patients, they have to look out for TB as well.

And the day you confirm someone has TB, let them be advised to take an HIV test and if positive, start them on antiretroviral treatment because they will heal much faster than someone being treated for TB alone. If only one condition is treated, the patient may die along the way. If you somehow manage to treat the TB, they will get it again because the underlying problem is not being taken care of. The two diseases are no longer separable.

The latest annual health sector performance report (AHSPR) shows that integration has improved tremendously but there are some academic works that paint a contrary picture. Why the discrepancy?

You have to look at the statistics well. If I were at zero and I have moved to 10 or 20 percent of the performance, I have improved. But it doesn't mean I have reached the optimum that is required. All TB patients are expected to be tested for HIV. So when we say integrate a service, we expect that every TB patient found in this country will receive an HIV test.

So when you look at the AHSPR and last year they tell you they were at 60 percent but this year they are at 70 percent they will say they have improved but we want it at 100 percent.

So why are we not integrating?

Many health workers did not understand this linkage initially. They needed training. It has taken time to have them trained to understand the close linkage between the two diseases. Also if you look at the structure of our services, if you have HIV, you are sent to a particular clinic and if you have TB you are sent to a particular clinic.

So the way our services are organised does not easily facilitate the process of integration. If somebody is in the TB clinic and that clinic does not offer HIV testing, they will refer the patient to the site that offers HIV testing. That alone affects the uptake of services. Probably they have been waiting for long and will promise to come back another day.

But they may not due to several factors because many may not have transport, we don't give them lunch. The vertical HIV and TB programmes are problematic. So what is the teaching now? At the primary healthcare facility we should try to integrate these services as much as possible. Where there is a TB service we should try and put an HIV service and vice versa. This will reduce the inconvenience to the patient.

Now that the need for integration is well understood why are we still wasting time as country?

In countries where TB and HIV services are under the same roof things are much better. For example in Zimbabwe these services are given under the same roof. Patients are not referred. If you go to Benin, it is the same thing. In Uganda, because our services have been structured separately, it takes time. When it comes to health workers, very few in HIV know how to give TB care and in TB it is the same situation.

Uganda needs to get resources and ensure that all health workers in HIV care know how to diagnose TB, treat it and follow up the patient. It should be the same thing on the TB side. Traditionally, the training has been separate. Joint planning by the national TB and AIDS control programmes is also still weak.

But your organisation has been working with Government for some time now. Why don't we have the TB and HIV care clinics merged?

When you are a partner in a country, you do not work in isolation of the government system. Uganda is stuck with the old system structure of vertical programming. So however good your intervention may be, it will be so difficult to integrate services like TB and HIV.

You can only tell them (TB and AIDS control programmes) to talk to each other, collaborate more often, and do what they can. But still where the Union has worked, there has been improvement in the uptake of TB-HIV services in these districts. (

Bird flu claims 9th victim in Indonesia this year

The Health Ministry says bird flu has killed a 37-year-old man in central Indonesia, marking the country's ninth fatality this year.

The Ministry's website said Monday that the man died July 30 in Yogyakarta province after being hospitalized for five days.

It confirmed that the man who lived near a chicken slaughterhouse was infected with the H5N1 virus after apparently coming into contact with sick birds.

The virus, which began ravaging poultry across Asia in 2003, remains entrenched in Indonesia. Experts fear it could mutate into a form that passes easily among people, potentially sparking a pandemic. But most human cases have been linked to contact with sick birds.

The World Health Organization says 359 people have died from it worldwide. Indonesia remains the hardest-hit country, accounting for 159 deaths. (