Indonesia has become one of the most attractive markets for investors during 2014-2015. Implementation of the Jaminan Kesehatan Nasional (JKN) scheme, initiated in January 2014, has been one of the major drivers besides the initiatives by the new government elected in 2014. As per the initial reports, patient volumes have significantly increased after the implementation of the scheme. (A few clinics in Bandung reported up to a 200% rise in patient volumes in the first 2 months after the scheme's implementation).

The market anticipates a high requirement of hospital beds, medical devices, affordable and low-cost medicines, and diagnostic services to meet the growing demand. This study explores the broad competitive landscape and regulatory environment, which can be considered by investors while entering the Indonesian healthcare market in 2015 and beyond.

The information contained in this research service was derived from published sources including the following: Government of Indonesia Websites, healthcare company websites, World Health Organization (WHO) data, World Bank data, International Monetary Fund (IMF) and press releases, public sources, the report's internal data bank, and industry key opinion leaders (KOLs). Primary and secondary research methodologies were used to gather and analyze the data presented in this study.

Key Topics Covered:

1. Executive Summary
2. Healthcare Market in Indonesia
3. Drivers and Restraints
4. Private Hospital Market in Indonesia
5. In-Vitro Diagnostics (IVD) Market in Indonesia
6. Medical Technologies (MT) Market in Indonesia
7. Pharmaceutical Market in Indonesia
8. Strategic Recommendations
9. Appendix

For more information visit http://www.researchandmarkets.com/research/m8m5ht/indonesia 

Health care is collapsing after nine months of conflict in eastern Ukraine, where a lack of medicines and vaccines has increasingly put people at risk from diseases such as polio, measles and tuberculosis, the World Health Organization said Friday.

Conditions are especially dire in the cities of Luhansk and Donetsk where people are trapped with little food. The fighting makes it hard to get to hospitals, which are often cut off from water and electricity.

In all, 5.1 million people are affected by the humanitarian crisis, including 1.4 million deemed highly vulnerable, the United Nations health agency said in a statement.

"We have special concerns for children, infants and the lack of vaccines. Ukraine in the past month had no vaccines in the country, we are warning," Dr. Dorit Nitzan, WHO representative in Ukraine, told a news briefing in Geneva. There is a "huge risk of vaccine-preventable diseases" she said. "Measles and polio are first on the list."

Nitzan said that as of Jan. 6, the death toll from the conflict between Ukrainian government forces and pro-Russian rebels stood at 4,808, with 10,468 wounded, based on reports from morgues and hospitals.

At least 32,500 people are living with HIV/AIDS in Donetsk and Luhansk and are "at high risk for interruption of care and control services," the WHO said, adding that only 10,000 were in treatment before the crisis began.

Cases of tuberculosis also appear to be increasing, and an estimated 40 percent of new TB patients are believed to have the multidrug-resistant form (MDR-TB), Nitzan said.

Ukraine's Health Ministry has asked the WHO to take over responsibility for procuring and distributing all essential medicines, the agency said. WHO is organizing mobile emergency units to provide primary health care in the east.

"The government had decided to cut the services to Luhansk and Donetsk cities, to the areas under the militants' control," Nitzan said.

Health care workers have not received salaries since June or July and many have fled the areas of fighting, she added.

source: http://www.dailystar.com.lb

The Ministry of Health has launched a 'house to house' polio immunization campaign for all children under the age of five.

The campaign will be run with the support from the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) and other stake holders. This will be from Jan.17 and then end on Jan.19.

The campaign is targeting over 7.5 million children in all the districts in the country. The immunizers are however expected to go beyond homes by targeting other places such as markets, streets and places of worship.

This is because it was found out that there might be a low motivation for people to participate in this or there might be no one at the homes to take children to be immunized.

To successfully carry out the exercise, Shs 14.9 billion has been provided as funding from the World Health Organization and UNICEF is to do social mobilization.

Uganda is responding to the Director-General of the World Health Organization who in May, last year, noted that there was a re-emergence of the polio virus causing a public health emergency of international concern (PHEIC).

In accordance with the International Health Regulations (IHR 2005), it was deemed right to fight the further spread of the immunisable disease.

Sarah Opendi, the Minister of Health said the ministry will put emphasis put on the 41 border districts since there is so much activity of migration going on.

These districts, she said, were reported to have people access immunization services much less than the others do.

In 2013 and early 2014, polio was detected in Somalia, Kenya and Ethiopia.

This raised an alarm to have the disease fought before it spreads farther to countries like Uganda.

Opendi warned against anyone who tries to sabotage this move adding that: "We will not hesitate to arrest anyone who tries to stop any child from being immunized. We are aware of religious beliefs against immunisation. We shall not tolerate this and so have made the police aware so it can arrest any culprits [who may be] against this move."

See more at: http://www.independent.co.ug

Two vaccines for treating the Ebola Virus Disease (EVD), which have already undergone the first phrase of trials, were deemed to be acceptably safe by the World Health Organization (WHO) Friday.

"The year 2014 will be remembered as a year the Ebola virus challenged humanity. I believe 2015 will be remembered as a year humanity used (its) best scientific minds to fight back," Marie-Paule Kieny, Assistant Director General of the WHO said.

According to a Xinhua report, WHO convened the second high-level meeting on Ebola vaccines Thursday to provide an update on the emerging safety and immunogenicity results of initial clinical trials and review the status of preparation for the next stage of efficacy trials in the three worst-affected West African countries of Liberia, Sierra Leone and Guinea.

The two potential vaccines that have been undergoing phase one safety tests on humans are ChAd3, made by Britain's GlaxoSmithKline, and VSV-EBOV, manufactured by the Public Health Agency of Canada and licensed by the US firm NewLink Genetics.

Kieny said that the evaluation of these two advanced vaccines was going on, noting that trials might begin in Liberia by the end of this month, and in Sierra Leone and Guinea in February. In addition, she also noted that the pharmaceutical giant Johnson & Johnson has started early-stage testing of one of its vaccines and was preparing for advanced testing in the Ebola-affected countries.

"The world is waiting for us to get these vaccines ready and out to (the) people with this virus raging through their communities," she added. As of Friday, the total number of cases attributed to EVD in West Africa reached 20,972, of which 8,259 people have died.

source: http://freepressjournal.in/

Training through electronic media and devices could help prepare more healthcare professionals, addressing possible shortages of doctors and nurses around the globe, according to a new review from the World Health Organization.

The research, carried out by Imperial College London, reviewed 108 studies and found that undergraduate students acquired knowledge and skills through online and offline e-learning as well as, or better than they do, through traditional teaching, according to an announcement.

The study separately evaluated the effectiveness of online learning, which requires an Internet connection, and offline learning, delivered through methods such as CD-ROMs or USB sticks. Both were found to be effective.

However, the researcher urge institutions to combine "eLearning" with traditional teaching for courses that involve acquiring practical skills.

Lead researcher Josip Car said eLearning holds particular potential for training health workers in developing countries, though barriers remain, including access to computers, Internet connections and learning resources. Universities, however, could help develop curricula and use online resources to help reach students internationally.

Many educational institutions already incorporate technology into training for healthcare careers. Not only can students read articles and watch video lectures on tablets and similar devices, but major medical centers are investing millions of dollars in on-site simulation centers to teach an array of skills, including surgery.

The American Medical Association ranked transforming medical education--including integrating the right technology--one of its top 10 issues to watch for 2015. Simulations, mobile apps and other technology increasingly are part of healthcare workers' curricula.

"Digital natives," a generation of healthcare workers who have grown up with technology, will drive innovation of healthcare down the road, according to digital health philosopher John Nosta.

Meanwhile, teaching hospitals can provide the resources and environment needed to effectively test out digital innovations and bring them to market, according to a recent Harvard Business Review article.

To learn more:

• read the review (.pdf)
• here's the announcement

source: http://www.fiercehealthit.com/

The United Nations World Health Organization (WHO) today convened in Geneva its second ever high-level meeting on Ebola vaccines access and financing, to review the current status of clinical trials and plans for Phase II and Phase III efficacy trials.

"We are here to take stock, plan the next steps, and make sure that all partners are working in tandem. We all want the momentum and sense of urgency to continue," Dr. Margaret Chan, Director-General of WHO said as she kicked off the meeting.

The most advanced candidate Ebola vaccine is scheduled to enter Phase III efficacy clinical trials in West Africa in January/February 2015, and if shown effective – will be available for deployment a few months later.

"You have given yourselves some very tight deadlines and are moving ahead quickly. In fact, what you are doing is unprecedented: compressing into a matter of months work that normally takes 2 to 4 years, yet with no compromise of international standards of safety and efficacy," Dr. Chan said.

"I think all of us have high expectations for the outcome of this meeting. As a WHO staff member who has spent several months in Guinea recently observed, what people need most is hope. They have watched families and communities torn apart by this virus for a year and are close to despair" she said, adding: "You can give them some of that hope."

Participating in today's discussions were representatives from manufacturers and research institutions, currently developing or testing Ebola candidate vaccines, Government officials from the Ebola-affected and neighbouring countries, and non-governmental organizations and partners.

Also on the agenda were discussions on funding mechanisms for potential Ebola vaccine introduction and the process for decision-making on introduction beyond Phase III trials. The first high-level meeting on Ebola vaccines access and financing was held on 23 October 2014.

"During this meeting, you will take a look at safety and immunogenicity data emerging from Phase I clinical trials of two candidate vaccines and review the status of other vaccines," Dr. Chan said, adding that no major safety signals have been reported to date.

Participants would also look at vaccine pipelines and consider the plans of companies to extend the safety database during Phase II evaluation. Equally important are discussions for Phase III efficacy trials in the three countries, she said.

"We will seek clarity on roles and responsibilities and how to coordinate the different actions. We also need some hard thinking about implementation challenges and how to overcome them."

Updating participants on the Ebola situation in Guinea, Liberia, and Sierra Leone, Dr. Chan said that 2014 did not end with a best-case scenario. Many health care workers are still getting infected, including nationals and doctors and nurses from foreign medical teams.

At the same time, the situation in Liberia looks "far more promising" than it did in October and November, she continued. But transmission continues. Some believe that the virus has moved from the cities into extremely remote rural areas, making it difficult to see what is really happening in Liberia.

In yet another turn of events, Sierra Leone has now outstripped Liberia as the worst-affected country. Several hundred cases are being reported each week.

source: http://www.un.org

Indonesia marked on Jan. 1, 2014 a historical milestone by launching the national health insurance (JKN) program, a platform for universal health care for citizens, targeted to be fully operational by 2019. A single institution called the Healthcare and Social Security Agency (BPJS Kesehatan) has been tasked with managing the JKN. The program is also pivotal because the government fully covers those deemed unable to afford a minimum standard of health care. However, problems like lack of health infrastructure and mounting hospital bills remain. The Jakarta Post's Hans Nicholas Jong talked recently to BPJS Kesehatan president director Fachmi Idris about the agency's first-year performance.

Question: It has been almost a year since the JKN program started. How has the performance of the BPJS Kesehatan been so far?

Answer: We just did research recently to measure the performance of the BPJS and public satisfaction. We surveyed 2,000 people from all provinces.

The government set a target of the public-satisfaction level to be 75 percent now and 85 percent by 2019. But now we already achieved 81 percent in our first year.

The survey measured satisfaction levels in all four service points: our office, our counters in hospitals, the hospitals themselves and primary health facilities, such as community health centers (Puskesmas).

What's the current status of claims from hospitals and pharmaceutical companies?

We don't pay claims to pharmaceutical companies. The ones who pay them are hospitals. The government has stipulated that we have to pay claims at least one month after patients receive medical treatment.

So if a patient gets medical treatment in November, then we have to pay for the claim by December. If not, then we will have a bad rapport. Then, the law on the BPJS also stipulates that we have to pay for claims within 15 days after hospitals submit all necessary documents.

If not, then we will be penalized. Therefore, we always pay all claims asked by hospitals 100 percent. As a matter of fact, we pay claims in an average of 2.8 days, much shorter than the deadline of 15 days.

If there are rumors of the BPJS Kesehatan not paying claims, then it must be debts from last year [that have not been paid by the previous organizations tasked with handling national health insurance]. [As of December], we have paid Rp 32.5 trillion for hospital claims.

In the past, there were some hospitals in Jakarta that did not accept JKN patients because the payment scheme, called the Indonesia Case-Based Groups (INA-CBG) system, had unfavorable rates. Has there been any revision on that?

In terms of rates, there is indeed a variation. The Health Ministry has decided that the payment scheme was divided into four regions — A, B, C and D. The ministry decided on the rates from the National Casemix Center.

After the rates were calculated, it was found that some tariffs indeed had to be increased, while others had to be decreased. Therefore, the ministry adjusted some of the rates in September.

There were 39 diagnoses for which rates had to be revised, such as orthopedics which was increased. While there are some issues with hospitals in Jakarta [that complain about the unfavorable rates], the majority of hospitals in several provinces are happy with the current system.

But if we look at the number of hospitals joining the JKN program, the number has been increasing, with 1,592 government hospitals and 617 private hospitals.

These private hospitals play a big role. So we have to really inform them [about the payment scheme]. This JKN program is a new system, so not all hospitals' management understand it.

Doctors also need to be informed that the payment from the BPJS is not to individual doctors. After that, the hospitals' management have to manage [their finances], and maybe in some places the management is not transparent. Some government hospitals say that they are not losing money [due to the JKN program].

So if there are hospitals that lose money, it is because of the management. Even a private hospital like Siloam does not lose money. If all hospitals are efficient [in their financial management], then there should not be a deficit.

What's your strategy to provide enough doctors to serve all people in Indonesia by 2019?

I have already done the math. Each year we have 6,000 to 10,000 graduates from 72 medical faculties in the country, considering that each faculty only produces 100 graduates. We will have enough additional doctors [by 2019]. We only have to work on the supply [of medical facilities] and that's not only the responsibility of the Health Ministry, but also local governance.

Is the money from premiums, both paid by the government and JKN members themselves, used purely for the provision of medical services or is some of it also invested?

The government stipulates that 90 percent of the funds that we receive have to be used for medical services. If we have more, then we will keep it for next year's medical-service purposes. But if there is still money left, then we could invest it in something liquid, such as deposits, SUN [government bonds], bonds and so on. Any results from the investment will go to the benefit of JKN members. The remaining 10 percent is for technical backup funds and our operational funds, such as to print cards, letters for members who have not paid their premiums and so on. However, it is hard to measure how much we invest because our cash flow is really fast.

What is your strategy on pushing workers from non-formal sectors to apply for the JKN program in 2015?

Actually we already have many workers applying. Our target this year is only 600,000 non-formal workers. The number that has applied is 7 million. It means people have high awareness and this trend will continue. Some of them applied even before they were sick while some of them only applied once they got ill. But we always urge people to apply for the program even before they are sick. 

source: http://www.thejakartapost.com/l

On a recent morning at Persahabatan Hospital in East Jakarta, patients, some from remote villages accessible only by boat, gathered in a waiting room. Nearby, lab technicians used new diagnostic technology to test sputum samples for multidrug-resistant tuberculosis, in an effort to tackle a growing caseload of the deadly disease.

Indonesia's recently sworn-in president, Joko Widodo, takes the reins of a rising economic power poised to play a larger role on the world stage. But he also confronts a set of entrenched public health problems fueled by the poverty in which millions of Indonesians still live. None is more urgent than the spread of drug-resistant tuberculosis across this sprawling archipelago.

Thanks to support from the Global Fund to Fight AIDS, Tuberculosis and Malaria, the international financing mechanism established in 2002 to help poor countries address these diseases, Indonesia has been able to provide the costly drugs for drug-resistant tuberculosis to patients free of charge. It has also supplied laboratories like the one at Persahabatan with the Xpert MTB/RIF device, which allows health workers to diagnose suspected cases of drug-resistant disease in under two hours (conventional methods take as long as eight weeks).

These are encouraging steps, but as Indonesia is learning, the tools of clinical medicine can do only so much. "This is a social disease," Dr. Erlina Burhan, the head of pulmonology medicine at Persahabatan, told me, referring to multidrug-resistant tuberculosis. "We have 7,000 new MDR cases a year, and many of those are defaulting on their treatment."

It's easy to understand why. For one thing, there's the financial strain; the drugs may be free, but as a recent multinational study found, the cost to patients — for everything from transportation and hospital stays to months of missed work — can amount to a year's earnings. And then there is the treatment itself: a grueling, two-year regimen of toxic drugs involving months of daily injections and possible severe side effects. And so stigmatized is tuberculosis in Indonesia that when volunteers go house to house looking for cases, families often try to hide sick relatives.

"Most of our patients don't know how the disease is transmitted," Dr. Burhan said, "so they return home and spread their drug-resistant strain to others." The World Health Organization estimates that every untreated MDR patient will infect, on average, between 10 and 15 people per year — and some of those may be their children, in whom tuberculosis is more difficult to diagnose and treat.

In October, the W.H.O. reported that improved data collection had revealed an epidemic significantly larger than previously estimated: In 2013, nine million people developed active tuberculosis, and of those, nearly half a million were infected with multidrug-resistant strains. Indonesia, home to the world's fifth-highest number of tuberculosis cases, is expected to publish its own prevalence survey soon; experts believe those figures will only add to the global burden.

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The White House should view these trends with alarm. After all, drug-resistant tuberculosis is a threat to people everywhere, including in the United States. An outbreak in New York City that started in the late '80s and involved drug-resistant strains cost at least $1 billion to quell. Given that caring for a single case of extremely drug-resistant tuberculosis can run more than half a million dollars, a similar outbreak today could impose crippling burdens on health departments at the front lines of the nation's defense. And the United States almost certainly underestimates its vulnerability.

Despite congressional calls to increase tuberculosis funding for the current year, President Obama proposed a 19 percent cut to the global tuberculosis budget of the United States Agency for International Development, which would put tuberculosis funding below $200 million for the first time in five years. The spending bill recently passed by Congress rejected those cuts and maintained level funding, at $236 million. That is still far below the $400 million per year public health advocates say is needed to combat the world's leading curable killer.

In 2013, President Obama pledged that America would contribute up to $5 billion to the Global Fund over the next three years. But by opposing increases to bilateral tuberculosis funding, the president jeopardizes this generous investment. While Global Fund grants support the purchase of drugs and diagnostics, like the $30,000 Xpert device, the agency doesn't have the in-country staff to ensure the tools' effective implementation. It's here that U.S.A.I.D. plays a vital role, by training technicians, strengthening supply chains and educating doctors and nurses about novel therapies.

Without that help, our aid dollars don't go nearly as far as they could. Between 2010 and 2012, for example, Indonesia, though a major recipient of Global Fund support, used only half of the funds allocated for tuberculosis control activities because it lacked the capacity to use that aid.

Perhaps the most tragic consequence of underfunding tuberculosis control, though, is that it undermines the fight against H.I.V. and AIDS. After billions of dollars and decades of research, antiretroviral drugs have transformed what was a death sentence into a manageable chronic disease. In spite of this monumental public health achievement, the leading killer of people living with H.I.V. today, accounting for one-quarter of AIDS deaths worldwide, is tuberculosis, a disease so neglected that the current first-line treatment is more than 50 years old.

Americans can no longer afford to be indifferent to the rise of drug-resistant tuberculosis. As Indonesia illustrates, technology alone can't solve the problem. At least in the short term, poor countries need the specialized expertise only America can provide. When the president's budget requests for the next fiscal year are released, they should reflect the reality that if drug-resistant tuberculosis is allowed to flourish in faraway slums, it will most certainly return to haunt us — and at potentially great cost.

soure: http://www.nytimes.com