Indonesia's conditional cash transfer program, Program Keluarga Harapan (PKH), provides cash to poor households in exchange for meeting specified health targets. It aims to reduce poverty and improve maternal and child health. But does it work?

After the success of Mexico's social assistance program PROGRESA (now Oportunidades), Indonesia followed suit in 2007 with the implementation of a pilot program, PKH. PKH set out to speed up the attainment of the Millennium Development Goals, especially poverty reduction and improved maternal and child health. Indonesia's PKH targets the poorest households with children or expectant mothers. The requirements typically include prenatal and postnatal checks, vaccinations and school enrollment and attendance.

Under PKH, program participants are required to have four prenatal visits; facility-based delivery (the original requirement was childbirth assisted by a trained health care provider); two postnatal visits; monthly weighing; vaccinations and vitamin A for children under five; and enrollment in primary and junior high school with a minimum of 85 percent attendance for school-aged children.

To the government's credit, PKH has been more successful than other social assistance programs in identifying and enrolling poor households. The impact evaluation finds that the program has increased participants' utilization of primary health care services, which suggests that the program has improved health care access for the poor. Unfortunately, the program has no effect on education. This is not surprising, however, since primary school enrollment is already high (greater than 80 percent) and the transition rate to junior high school is fairly high (roughly 75 percent).

Even though the program is successful in getting participants to 'show up' to meet the health requirements, participants' health-seeking behavior unfortunately has not translated to improvements in long-term outcomes—such as reductions in the incidence of low birth weight and mortality. The lack of impact here is partly related to the supply side of the health care market.

Conditional cash transfer (CCT) programs operate best when the health care system has adequate supply to absorb the additional demand stemming from the program requirements. In some places, there is insufficient supply or no excess capacity in the health care system, so there is a change in price, quantity or quality from the supply side—which can dampen the effects of the program. In particular, higher prices are expected in the short term, before new health care providers can enter the market to increase supply. This increase in demand may also reduce quality of care as providers see more patients.

Indonesia's public providers are also allowed to hold private practice part-time, and this potentially impacts on the program. As the CCT increases demand for health care—for providers with both public and private practices—they can respond with higher prices in private practice, thereby increasing average prices.

Also, public providers may opt to pursue their more lucrative private practice. This could strain the public system and quality of care would suffer. The combination of lower quality and higher prices could limit health care access, thereby defeating the purpose of the program. This possibility is a particular concern for households that just miss the CCT cut-off.

PKH is planned to go national this year. It will be interesting to analyse the long-term effects and how the effects change as the program expands. The supply of health care will become an even more important issue with the implementation of the national health insurance system, Jaminan Kesehatan Nasional.

The Indonesian government is continuing to seek better ways of delivering health care services to the public and to the poor. As the government is taking steps to strengthen the health care system—through efforts such as PKH—we can be cautiously optimistic for what the future holds.

source: http://www.asianscientist.com

The World Health Organisation (WHO) says it is finalising a plan to stop the spread of the deadly Ebola virus, with details to be released early next week.

The death toll from the Ebola outbreak in West Africa has risen to 1,427, according to the latest figures released by the WHO.

Liberia remains the worst-affected country with 624 deaths. Guinea has seen 406 people die while the disease has killed 392 in Sierra Leone and five in Nigeria.

The UN agency says it has drawn up a draft strategy to combat the disease over the next six to nine months.

David Nabarro, senior United Nations system coordinator for Ebola, who was travelling with the WHO's Dr Keiji Fukuda in Liberia, said the strategy would involve ramping up the number of health workers fighting the disease.

"It means more doctors, Liberian doctors, more nurses, Liberian nurses, and more equipment," he said.

"But it also means, of course, more international staff."

The announcement comes after aid agency Medecins Sans Frontieres (MSF), which has urged the WHO to do more, said that the speed of the crisis was outstripping the ability of authorities to cope.

The affected West African countries were already struggling with few doctors and fragile healthcare systems before the Ebola outbreak was first identified in March.

Health workers have been among the hardest hit by the disease.

The head of MSF, Joanne Liu, told Reuters that the fight against Ebola was being undermined by a lack of international leadership and emergency management skills.

In a sign of spreading regional alarm, Senegal, West Africa's humanitarian hub, said it had blocked a UN aid plane from landing and was banning all further flights to and from countries affected by Ebola.

The WHO has repeatedly said it does not recommend travel or trade restrictions for countries affected by Ebola, saying such measures could heighten food and supply shortages.

Gabon has also announced its suspension of air and sea links to the four affected countries, following the lead of a number of regional nations who have defied WHO advice in an attempt to isolate themselves from the disease.

Families hiding infected loved ones

The WHO said the scale of the outbreak has been underestimated and that many cases have probably gone unreported, especially in Liberia and Sierra Leone.

Families hiding infected loved ones and the existence of "shadow zones" where medics cannot go mean the Ebola epidemic is even bigger than thought, the agency said.

The WHO said it is now working with the MSF and the US Centers for Disease Control and Prevention to produce "more realistic estimates".

The stigma surrounding Ebola poses a serious obstacle to efforts to contain the virus, which causes regular outbreaks in the forests of Central Africa but is striking for the first time in the continent's western nations and their heavily populated capitals.

"As Ebola has no cure, some believe infected loved ones will be more comfortable dying at home," the WHO said in a statement detailing why the outbreak had been underestimated.

"Others deny that a patient has Ebola and believe that care in an isolation ward - viewed as an incubator of the disease - will lead to infection and certain death."

In other cases health centres are being suddenly overwhelmed with patients, suggesting there is an invisible caseload of patients not on the radar of official surveillance systems.

US experts have played down hopes of a cure for Ebola after two American health workers were sent home from hospital after being cleared of the virus.

source: http://www.abc.net.au

The World Health Organization (WHO) has warned that the global fight against HIV risks stalling without stronger preventative treatments for transgender people and gay and bisexual men.

As well as offering medical advice, WHO has recommended that countries "remove the legal and social barriers that prevent many people from accessing services". In countries which do not prevent discrimination against groups such as transgender people and gay men, seeking healthcare often carries severe risks which render treatment inaccessible.

The message comes as WHO issues new "guidelines on HIV prevention, diagnosis, treatment and care for key populations", ahead of an International AIDS Conference to be held in Australia later this month.

In a press release, WHO noted that transgender women are at particularly high risk, being "almost 50 times more likely to have HIV than other adults". Men who have sex with men (MSM) are "19 times more likely to have HIV than the general population".

Other key risk groups are sex workers, people in prison, and people who inject drugs.

Dr Gottfried Hirnschall, Direction of the HIV Department at WHO, said: "Failure to provide services to the people who are at greatest risk of HIV jeopardizes further progress against the global epidemic and threatens the health and wellbeing of individuals, their families and the broader community."

The announcement marks the first time that WHO has strongly recommended pre-exposure prophylaxis (PrEP) for MSM "as an additional method of preventing HIV infection", to be used in conjunction with condoms.

"Modelling estimates that, globally, 20-25% reductions in HIV incidence among men who have sex with men could be achieved through pre-exposure prophylaxis, averting up to 1 million new infections among this group over 10 years," WHO states.

PrEP is a preventative treatment for people who are HIV-negative, but at high risk of contracting the infection. The treatment involves taking one anti-retroviral pill daily and, if used consistently, has been shown to reduce the risk of infection by up to 92%.

Guidelances released at last year's International AIDS Conference recommended that antiretroviral treatment should be offered to HIV-positive patients at an earlier stage in the progression of the infection.

Earlier this year, the U.S. Centre for Disease Control (CDC) extended its own recommendations on the preventative usage of the PrEP drug Truvada to new groups.

Results of another study released this week showed that the use of Truvada as PrEP also lowers inflectional rates of genital herpes by 30%.

In the UK, the drug is currently still in its experimental trial period, but some campaigners are already calling for it to be made available on the NHS.

source: www.pinknews.co.uk

Over the last five years, World Health Partners (WHP) has worked to develop a system of healthcare delivery that meets the needs of those most vulnerable in India: rural communities who constitute three-fourths of the population. Last month, with the launch of a new collaborative project in Kisumu, western Kenya, WHP took the first step in realizing a foundational goal for the organization: expansion into Africa.

At first glance, expansion into Africa seems a counterintuitive step for WHP. Our expertise is in India. We have spent half a decade navigating challenges unique to the Indian health system. And, though we are proud of our progress, there remains no shortage of work in rural India. Yet, WHP's mission has always been to deliver health services to those in need, a philosophy that is agnostic to country or region, and one that means working where the needs are greatest.

In my 25+ years of working in global health, I have seen countless programs take root and grow only to wither and fade - programs filled with great ideas that failed to adapt to local contexts, or programs with great promise that failed to innovate in the face of the uncertainties of low resource, weak infrastructure settings. Our experience working in rural Uttar Pradesh and Bihar, two of India's largest and poorest states, has been a crucible of learning and innovation for us, and we relish the challenge of applying these lessons to a new country.

After over 120,000 successful telemedicine consultations in India, and having served millions of patients through our 6,000 rural Sky franchisees, we trust that our model is making a difference in the lives of those we reach.

Our new project in Kenya, implemented in collaboration with Kisumu Medical and Educational Trust (KMET), was born from a mutual desire to improve health services for rural Kenyans, many of whom remain underserved by the existing health system.

Kenya, like most countries in the developing world, has struggled to relocate doctors, nurses, and clinical services close to the rural communities that need them the most, communities in which nearly 75% of Kenya's population still lives. In the face of an underdeveloped rural infrastructure and insufficient human resources for health, we believe our Sky network can be a catalyst for achieving universal health coverage.

For many rural communities of western Kenya, the first point of medical care is the local community health worker (CHW). The Sky franchise network transforms rural CHWs into sources and conduits for affordable and timely medical services through a combination of training, reliable supply of medicines and diagnostics, and telemedicine links to qualified doctors in urban centers.

This is a small beginning for WHP's efforts in Africa. Existing human resources like CHWs in rural Kenya are present in every community; the native sense of entrepreneurship is a universal resource and the lynchpin of human ingenuity. We are confident that the linkages we help form, along with our micro-franchising approach, will not only empower local health workers, but give them the ownership necessary to truly bridge, sustainably and at scale, the access challenges that exist in much of Africa.

source: www.huffingtonpost.com

Posing serious threat to global health, two forms of tuberculosis (TB) have become resistant to rifampicin, regarded the most effective drug against TB, researchers from India and the US say.

The two forms are multi-drug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB).

Scientists from the two countries have found that a new compound – 24-desmethylrifampicin – has much better anti-bacterial activity than rifampicin against multi-drug-resistant strains of the bacteria that cause TB.

This is an important step toward development of new drugs that can transcend antibiotic resistance issues.

'We believe these findings are an important new avenue toward treatment of multi-drug-resistant TB,' said Taifo Mahmud, professor at Oregon State University in the US.

'The approach we are using should be able to create one or more analogs that could help take the place of rifampicin in TB therapy,' Mahmud added.

A combination of genetic modification and synthetic drug development was used to create the new compound.

Further development and testing will be necessary before it is ready for human use, researchers said.

'Drug resistance in rifampicin and related antibiotics has occurred when their bacterial RNA (Ribonucleic acid) polymerase enzymes mutate,' Mahmud said, 'leaving them largely unaffected by antibiotics that work by inhibiting RNA synthesis.'

The new approach works by modifying the drug so that it can effectively bind to this mutated enzyme and again achieve its effectiveness.

'We found out how the antibiotic-producing bacteria make this compound, and then genetically modified that system to remove one part of the backbone of the molecule,' Mahmud added.

Collaborators on this research were from the University of Delhi and the Institute of Genomics and Integrative Biology in New Delhi.

In 1993, resurging levels of TB due to this antibiotic resistance led the World Health Organization to declare it a global health emergency.

Today more than a million people around the world are dying each year from TB. After AIDS, it remains the second most common cause of death by infectious disease.

The study appeared in the Journal of Biological Chemistry.

What is TB?

TB or Tuberculosis is an infectious disease caused by a bacterium called mycobacterium tuberculosis. TB most often affects the lungs, but contrary to popular belief, it can affect almost all other organs such as the uterus, fallopian tubes, intestine, kidney, bones, meninges (lining around the brain and spinal cord). It is no wonder that during the early days of this disease it was commonly called 'consumption', because the bacterium would infiltrate almost all parts of the human body. Read ten facts you didn't know about TB.

source: www.thehealthsite.com

Indonesia became the newest country to mandate graphic photo warnings on cigarette packs Tuesday, joining more than 40 other nations or territories that have adopted similar regulations in recent years.

The warnings, which showcase gruesome close-up images ranging from rotting teeth and cancerous lungs to open tracheotomy holes and corpses, are an effort to highlight the risks of health problems related to smoking.

Research suggests these images have prompted people to quit, but the World Health Organization estimates nearly 6 million people continue to die globally each year from smoking-related causes. The tobacco industry has fought government efforts to introduce or increase the size of graphic warnings in some countries.

Here are a few places where pictorial health warnings have made headlines:

Indonesia

The law: 40 percent of pack covered by graphic photos.

Timing: Deadline to be on shelves was June 24.

Background: Many tobacco companies missed Tuesday's deadline to comply with the new law requiring all cigarette packs in stores to carry graphic warning photos. Indonesia, a country of around 240 million, has the world's highest rate of male smokers at 67 percent and the second-highest rate overall. Its government is among the few that has yet to sign a World Health Organization treaty on tobacco control.

Thailand

The law: Portion of cigarette packs that must be covered with graphic health warnings rising from 55 percent to 85 percent.

Timing: Change will take effect in September.

Background: Last year, the Public Health Ministry issued a regulation increasing the level of coverage to 85 percent. Tobacco giant Philip Morris and more than 1,400 Thai retailers sued, and a court temporarily suspended the order. On Thursday, the Supreme Administrative Court ruled that the regulation can take effect before a lower court reaches a final verdict in the lawsuit.

Australia

The law: No cigarette brand logos permitted; graphic health warnings required on 75 percent of front and 90 percent of back.

Timing: Plain packaging law went into effect in 2012.

Background: Australia became the first country in the world to mandate plain cigarette packs with no brand logo or colors permitted. Instead, the packs are solid brown and covered in large graphic warnings. Tobacco companies fought the law, saying it violated intellectual property rights and devalued their trademarks, but the country's highest court upheld it. Figures released this month by the country's Bureau of Statistics found that cigarette consumption fell about 5 percent from March 2013 to the same period this year. The World Trade Organization has agreed to hear complaints filed by several tobacco-growing countries, but other governments have expressed interest in passing similar laws. Smokers make up 17 percent of Australia's population.

United States

The law: No graphic pictures on packs.

Timing: The government stepped away from a legal battle with tobacco companies in March 2013.

Background: There are currently no pictorial warnings on cigarette packs in the U.S. After the tobacco industry sued, a Food and Drug Administration order to include the graphic labels was blocked last year by an appeals court, which ruled that the photos violated First Amendment free speech protections. The government opted not to take the case to the U.S. Supreme Court, but will instead develop new warnings. About 18 percent of adult Americans smoke.

Philippines

The law: Graphic warning legislation approved this month requires 50 percent of bottom of the pack to be covered by graphic warnings.

Timing: Legislation awaits president's signature.

Background: The Philippines is expected to join a handful of other countries that put graphic warnings at the bottom of their packs, meaning they are not visible when displayed on store shelves. Anti-smoking advocates say labels on the bottom of the packs are less effective, and have denounced tobacco industry involvement in the implementation process. Health officials said around 17 million people in the country of 96 million, or 18 percent, smoked in 2012.

Uruguay

The law: Graphic warnings cover 80 percent of packs.

Timing: Regulations implemented in 2010.

Background: Uruguay, a leader in strict tobacco controls, mandated what were the largest graphic warnings ever in 2010. Eighty percent of packs must be covered by the labels, including one depicting a person smoking a battery to show that cigarettes contain the toxic metal cadmium. Uruguay has backed Australia at the WTO, telling the trade body that smoking is "the most serious pandemic confronting humanity." Philip Morris International sued Uruguay over the law; the case is still pending

source: www.poconorecord.com

Tobacco companies have largely ignored an Indonesian deadline to put graphic health warnings on all cigarette packs being sold, another setback for anti-smoking efforts in a country that's home to the world's highest rate of male smokers and a wild, wild west of advertising.

Despite having a year and a half to prepare warning photos that are to cover 40 per cent of cigarette packs, most tobacco companies failed to meet Tuesday's deadline, according to the National Commission for Child Protection. It found little sign of change in brands being sold in Jakarta and 11 other cities across the archipelago.

"This clearly indicates that the cigarette industry has defied Indonesian law," said commission chair Arist Merdeka Sirait. "The government has been defeated by the cigarette industry."

Only 409 of the more than 3,300 brands owned by 672 companies nationwide had registered the photos they plan to use on their products as of Monday, according to the Food and Drug Monitoring Agency. They were given a choice of five images last June.

Health Minister Nafsiah Mboi said companies that missed the deadline will be issued warnings, and those that fail to comply could eventually be fined up to US$42,000 and face five years in prison.

Indonesia's biggest cigarette producer, Philip Morris-owned Sampoerna, said it began distributing products with the new warnings on Monday, but needed more time to clear out existing stock. But the labels must be displayed on shelves by Tuesday, Mboi said.

"We believe the government will implement the regulation consistently and fairly, so as to realise a climate of healthy competition among cigarette manufacturers, as well as providing clear information about the impact of smoking on health," Sampoerna spokesman Tommy Hersyaputera said.

Indonesia has a long history of delaying tobacco regulations. The graphic warnings stem from health regulations that passed in 2009, though it wasn't until 18 months ago that a specific decree was issued for implementation. And Indonesia is one of the few countries that has not joined a World Health Organisation tobacco treaty. The order has taken years to reach President Susilo Bambang Yudhoyono's desk, and he still has not signed it. He will leave office in October after elections next month.

Tobacco control is particularly contentious in Indonesia, the world's fifth-largest cigarette producer and a growth market for the industry. Farmers hold rowdy protests when restrictions are proposed, and lobbyists maintain tight connections with politicians in a government rife with graft.

Many forms of tobacco advertising long banned in the West remain ubiquitous here. Towering billboards and LED screens scream messages such as, "Marlboro Ice Blast ... crush it, unleash it." At the main international airport, a bright blue advertisement for Clas mild cigarettes urges, "Act Now! Talk less do more." Tobacco advertisements are still on television, and although new regulations ban sponsorship of events, some companies have continued that practice.

Tobacco-related illnesses kill at least 200,000 each year in the country, which has a population of around 240 million. A national survey in 2012 found that 67 per cent of all males over age 15 smoke – the world's highest rate – while 35 per cent of the total population lights up, surpassed only by Russia.

Most Indonesian men buy strong and pungent kreteks, filled with a mix of tobacco and cloves. But so-called white cigarettes, such as US-based Philip Morris International's Marlboro, have become more popular in recent years. All brands are cheap, selling for about US$1 a pack, making it easy for children to take up the habit.

source: www.scmp.com 

The deadly Ebola virus outbreak in West Africa has hit "unprecedented" proportions, according to relief workers on the ground.

"The epidemic is out of control," Dr. Bart Janssens, director of operations for Doctors Without Borders, said in a statement.

There have been 567 cases and 350 deaths since the epidemic began in March, according to the latest World Health Organization figures.

Ebola virus outbreaks are usually confined to remote areas, making it easier to contain. But this outbreak is different; patients have been identified in 60 locations in Guinea, Sierra Leone and Liberia.

Officials believe the wide footprint of this outbreak is partly because of the close proximity between the jungle where the virus was first identified and cities such as Conakry. The capital in Guinea has a population of 2 million and an international airport.

People are traveling without realizing they're carrying the deadly virus. It can take between two and 21 days for someone to feel sick after they've been exposed.

Ebola is a violent killer. The symptoms, at first, mimic the flu: headache, fever, tiredness. What comes next sounds like something out of a horror movie: significant diarrhea and vomiting, while the virus shuts off the blood's ability to clot.

As a result, patients often suffer internal and external hemorrhaging. Many die in an average of 10 days.

"We have reached our limits," Janssens said.

Doctors Without Borders, also known as Médecins Sans Frontières, is the only aid organization treating people affected by the virus. Since March, they have sent more than 300 staff members and 40 tons of equipment and supplies to the region to help fight the epidemic.

Still, they warn, it's not enough.

"Despite the human resources and equipment deployed by MSF in the three affected countries, we are no longer able to send teams to the new outbreak sites."

The good news is that Ebola isn't as easily spread as one may think. A patient isn't contagious — meaning they can't spread the virus to other people — until they are already showing symptoms.

Health officials have urged residents to alert MSF or local physicians at the first sign of flu-like symptoms. While there is no cure or vaccine to treat Ebola, MSF has proved it doesn't have to be a death sentence if it's treated early.

Inside isolation treatment areas, doctors focus on keeping the patients hydrated with IV drips and other liquid nutrients. It's working. Ebola typically kills 90% of patients. This outbreak, the death rate has dropped to roughly 60%.

MSF says they'll continue to isolate and treat Ebola patients in West Africa with the resources they have available but urge for a "massive deployment" by regional governments and aid agencies to help stop the epidemic.

World Health Organization officials say they're planning high-level meeting for the Minister of Health in the subregion July 2 and 3 to discuss the deployment of additional resources and experts to the area.

The outbreak will be considered contained after 42 days with no new Ebola cases — that's twice the incubation period.

source: fox2now.com