I have experienced healthcare systems in Indonesia, Singapore, and the UK. After living in the UK for ten years, I am converted into a staunch supporter of the National Health System (NHS) of the UK. Of course I admit that the NHS is not without its failings. For one, its cost keeps on ballooning, and the NHS has been under the threat of bankruptcy right from her inception 60 years ago.

'Cradle to Grave'

However, the UK spends much less money per capita on healthcare compared to the USA. Countries that rely on private healthcare system provide a rather cruel treatment to certain segments of the society. If one has money, one can receive the best treatments on the planet. However, woe befalls those with empty pockets for they will not receive a decent service. This is why I adore the NHS; a system that allows both princes and paupers to receive equal healthcare treatments. I do have to give a disclaimer as I currently work for the NHS so please expect a rather biased view.

It would be desirable if the Indonesian healthcare system is able to adapt some basic ideas from the NHS. As you are aware, both in Jakarta and the rest of Indonesia, there has been a recent change to improve access to secondary healthcare by making it free for those who earn below certain levels of income. Understandably, this initiative has resulted in overcrowding of these secondary healthcare centres, that is, the hospitals, and led to some tragic consequences such as deaths due to delay in initiating treatments.

'Gatekeepers' of the system

Remedial works have been tried, especially in ensuring that referrals from Puskesmas are required to have services provided in the hospitals. This is where, I believe, we can learn from the NHS. The structure in the NHS is quite similar to the Indonesian healthcare systems. The function of Puskesmas is delivered by General Practitioners (GP) here. Every patient would need to be seen by the GP before being referred to a specialist in the hospital. Thus, GPs act as 'gatekeepers' in the NHS.

To be able to perform their duties fully, GPs in the UK are trained further for 5 years after they graduate from medical schools. Therefore, GPs in the UK are experts in managing chronic diseases. They are also given economic power to enable them to buy services from the hospitals. Subsequently, these GPs will tend to buy high quality services from hospitals.

Function of the Puskesmas

We may be able to do the same with our Puskesmas system. The Puskesmas doctors and nurses can also have the function as those 'gatekeepers'. Their knowledge and skills should be upgraded so that not only doctors who have just graduated from medical schools are able to deal with complicated illnesses. These new doctors should receive supervision from more experienced doctors so that chronic diseases can be managed in Puskesmas and only difficult cases are referred to the hospital. This is because hospital care is expensive and resource-intensive.

Furthermore, Puskesmas should also be given more financial power and they should be able to manage their own budgets. The gravest medical problems in Indonesia are still due to malnutrition and infection. Non-communicable diseases, such as heart attack and diabetes, are catching up quickly. These problems are preferably treated in Puskesmas, hence we should strengthen the Puskesmas system to deal with these fundamental problems.

source: www.globalindonesianvoices.com

Since it was first reported in 1968, Indonesia has now become endemic for dengue contributing the second-largest number of cases globally. With a high incidence rate, the disease has been reported from all across the country. Victory over dengue is possible but it will require coordinated action by different sections of the society — the community, health practitioners, different sectors of the government as well as the media.

Indonesia is not alone in its fight against dengue. The disease has shown a 30-fold increase globally over the past five decades. Some 50 million to 100 million new infections are estimated to occur annually in more than 100 endemic countries. Every year, hundreds of thousands of severe cases arise, resulting in 20.000 deaths. Today, on World Health Day, WHO will focus global attention on vector-borne diseases such as dengue that are putting our health at risk, at home, at the workplace and when we travel.

Dengue is a complex disease, with multiple virus strains and an extremely versatile and efficient vector — the day-biting mosquito.

The dengue mosquito breeds in fresh water and even a small amount — as little as 5 milliliter to 10 milliliter is enough to breed the mosquito. The mosquito develops from larva to fullgrown mosquito in a week. This makes water collecting in your coolers, air conditioners, planters, coconut shells and used tires ideal breeding grounds for the mosquito. Surveillance and vigilance for mosquito breeding grounds is one of the most important actions you can take to prevent dengue.

Dengue is a climate-sensitive disease and its vector dynamics are strongly influenced by environmental factors, population dynamics and climate change. Despite these challenges, dengue is a preventable disease. The solution lies in a united and sustained effort from all of us. Ministries of health alone cannot control dengue. Dengue is everybody's concern and its control and prevention requires a committed, multisectoral engagement with a strong political will.

Since there is no antiviral drug or vaccine, mosquito control is the backbone of dengue prevention.

Good environmental management, effective solid waste management and better management of water resources are key elements of mosquito control.

No single approach works on the mosquitoes and hence an integrated approach needs to be practised.

Educating and empowering communities to take ownership of mosquito control in their houses and neighborhoods is the cornerstone of a sustainable mosquito-control program.

Parents must protect themselves and their children from mosquito bites, using mosquito repellents, sleeping under bednets and wearing clothing that covers as much of the body as possible. Communities must come together to check old tires, potted plant bases and empty vessels, especially at construction sites and community trashcans. Mosquito breeding grounds in public spaces such as hospitals, offices and schools must be regularly checked and eliminated.

As of now, no vaccine is available to prevent dengue. However, there is optimism about vaccine development, with several candidate vaccines in various advanced stages of clinical trials.

We must continue to sustain the gains made in reducing case fatality and continue educating and re-educating doctors, nurses and health workers on clinical management of dengue. We need to strengthen referral systems, ensuring timely referral of patients to appropriate levels of health care to reduce deaths due to dengue. The World Health Organization remains committed to support Indonesia in its fight against dengue.

source: www.thejakartaglobe.com

World philanthropist and Microsoft founder Bill Gates will collaborate with the Tahir Foundation and other Indonesian conglomerates on a special sustainable healthcare program, a senior minister said Wednesday.

"The government appreciates the initiative and believes that the Gates and Tahir foundations will run it transparently and with accountability," Coordinating People's Welfare Minister Agung Laksono told a press conference.

Agung said the collaboration would establish the Indonesian Health Fund, which was a charity pool that business people and philanthropists across the country could donate to.

The minister revealed that Gates was scheduled to visit Jakarta, Indonesia, on April 5, to sign a memorandum of understanding (MoU) on the program with Dato Sri Tahir, founder of the Tahir Foundation, and eight other conglomerates.

During his stay in Jakarta, Gates will also visit public health centers (Pukesmas) and meet business people, government officials and media leaders.

According to Agung, Gates and Tahir had a successful collaboration last year; a joint-donation effort called the Global Fund to Fight AIDS, Tuberculosis and Malaria, which raised US$207 million. Both foundations donated $103.5 million.

"Around 75 percent of the donation joint-effort is currently being used to treat malaria, tuberculosis, HIV-AIDS and family planning in Indonesia," he said.

Agung added that the Global Fund to Fight AIDS, Tuberculosis and Malaria had been established by prominent UN figures including Kofi Annan.

According to statistics from the World Health Organization (WHO), around 50 percent of the Indonesian population lives in malaria-endemic areas. The same data also shows that out of an annual 30 million malaria cases 30,000 died every year across the country.

Tahir, who is also a chairman and CEO of the Mayapada Group, said that he could not disclose the names of the eight Indonesian conglomerates, but did confirm that they were committed to the program.

"The business people agreed to donate a total of $80 million to this program," he said.

He said that the initiative would promote philanthropy, especially for health care, like in European countries and the US.

Tahir cited Warren Buffet, the richest man in the US, who had donated 90 percent of his wealth to the Gates Foundation.

According to Tahir, Indonesia would be the first nation in Asia to have successful philanthropic collaboration. (gda)

source: www.thejakartapost.com

The Health Ministry plans to conduct public health research to obtain data on the sufficiency and safety of the food eaten by Indonesians.

The 2014 Total Diet Study is aimed at giving an overall picture of current consumption patterns among Indonesians nationwide.

"This study is very important because we are still dealing not only with chronic hunger and malnutrition [in some areas] but also over-nutrition, which is more dangerous as it can cause non-infectious diseases," Health Minister Nafsiah Mboi said at the opening of the 2014 Health National Work Meeting in Jakarta on Tuesday, as quoted by Antara.

With increased health risks caused by a double burden of nutritional problems, the minister said she hoped the Total Diet Study would deliver a comprehensive picture of food consumption patterns in Indonesia in order to determine the best way to tackle the existing problems.

The study will involve two elements -- an Indonesian Food Consumption Survey (SKMI), which will be held in all 34 provinces, and Food Chemical Taints Analysis (ACKM), which will be piloted in Yogyakarta after the SKMI results are issued.

The ACKM will determine the levels of food contamination based on international standards.

"The analysis aims to monitor food taints, such as formalin that can cause kidney failure, as such cases have been increasing in the country," Nafsiah said.

Yogyakarta has been chosen as the pilot area for the ACKM as it has a wide variety of local foods and is therefore considered representative of the many Indonesians' dietary behavior. Previous surveys also revealed a number of food contamination cases in the province.

The Health Ministry, which will work on the survey together with the Food and Drug Monitoring Agency (BPOM), has come up with a list of 27 pollutants that will be tested based on a food examination standards issued by the World Health Organization (WHO). The food taints due to be tested include pesticides, heavy metals and microbiological factors. (ebf)

source: www.thejakartapost.com

India was officially declared polio-free last week, clocking three full years after its last polio case was reported in 2011. It is a healthcare landmark for a country of 1.3 billion people to be proclaimed free of the disease by the World Health Organization. Other than Afghanistan, Pakistan and Nigeria, the rest of the world is currently rid of polio.

The event could be a signal for global drug firms – in that it proves that India's market is big and real, and that there is a possibility of reaching every Indian if the price is right.

Polio is a vaccine-preventable disease that has long been eradicated in the West. But its purging from India, a populous country with a significant number of poor and illiterate people, is particularly momentous. The challenges are not just poor sanitation and polluted water. Public health systems are inadequate and the per-capita spend on healthcare is among the lowest in the world. India spends $43 per head on healthcare while neighboring Sri Lanka invests $87 and China spends $155.

Even as recently as 2009, nearly half the world's new polio cases were being reported from India. The debilitating disease is carried through tainted food or water. The virus attacks the central nervous system, paralyzing muscles and stunting appendages.

The country has purged itself of the disease by treating it as a public health crisis situation. The government mounted a concentrated campaign of never-before proportions, financing it with over $2.5 billion of public money as well as funds from non-profit organizations. A newer, more efficient vaccine helped too.

The government launched the Pulse Polio immunization campaign in 1995, bombarding cities and towns with the message about vaccinating the most vulnerable segment – all children under the age of five. The message about the drops of oral police vaccine reached every village and hamlet in a vast country. Millions of health workers waded through rivers, climbed up hills and crossed sandy stretches to reach every family. They battled widespread superstition against vaccination and allayed fears that the polio vaccine was a tool to sterilize people.

While boosting routine immunization, the country has guarded its borders from importing the virus from the neighboring territories. It recently made it mandatory for travelling coming in from countries with polio to produce certificates as proof of vaccination.

Polio's eradication is a public health signpost for India. To be sure, if mass vaccinations are discontinued and the government drops its guard, the disease could return with a vengeance. For now, the success could be the foundation stone on which more such intensive and routine immunization programs could be built to protect the world from disease and death.

source: www.forbes.com

When Mount Merapi in Central Java, Indonesia, erupted in October 2010, the lava flows and ash plumes hit many people unprepared. Around 350 000 people who lived on the slopes of the volcano within a radius of 10 km were evacuated to emergency shelters. But because they refused to leave their homes or returned while the eruptions were still continuing, more than 300 people were killed during the disaster.

Indonesia with more than 17 000 islands is sitting on the so-called "ring of fire" of the Pacific, Eurasian and Australian tectonic plates and is one of the world's most disaster-prone countries. The archipelago is frequently hit by floods, earthquakes, volcano eruptions, tsunamis, storms and landslides. It is also at risk of man-made disasters such as mudslides, as well as chemical and nuclear accidents. In addition, Bali, Indonesia's favourite tourist destination, has been a target of terrorist attacks in the past.

"Most of the disasters cannot be predicted but we learned our lesson from past experiences and are much better prepared today," says Dr Lies Untari, the focal person for Emergency at the Tebet Community Health Centre. "The local centres are on a 24-hour alert and have all the necessary material including for example boats, medicines and generators on stock, ready for deployment at any time."

Including crisis prevention in development planning

Disaster risk reduction is a high priority for the Indonesian Government. As disasters have the potential to stop and even reverse a country's development in its tracks, Indonesia has integrated crisis prevention, emergency response and recovery measures into its development planning and budgeting.

Already in 2007, the government adopted a Disaster Management Law that made disaster risk reduction activities mandatory. Supported by WHO and other agencies, the Government has since expanded its emergency preparedness and response programme. A National Disaster Management Agency coordinates the response to all disasters and produces risk maps for many provinces. Within the Ministry of Health, the Centre for Health Crisis Management was established and designated a WHO Collaborating Centre for Training and Research on Disaster Risk Reduction in 2012 due to its extensive knowledge and experience in emergency risk management.

"We hope that the training and research conducted by the Collaborating Centre will provide Indonesia with more evidence and innovative solutions, enabling this high-risk country to better protect its people from disasters," says Dr Khanchit Limpakarnjanarat, the WHO Representative in Indonesia.

Engaging with communities

To ensure immediate health assistance in case of an emergency, WHO supported the Ministry of Health to create 9 regional centres across the country.

"The main goal was to bring health services closer to the affected population," explains Dr Indro Murwoko from the Centre for Health Crisis Management. "The regional centres were established to overcome some of the typical obstacles that often delay assistance, such as destroyed infrastructure, disrupted communications and lack of resources."

In recent years, the Government is focusing more on disaster prevention and damage mitigation. To increase resilience to natural disasters within the mainly rural communities, the Ministry of Health is engaging with community health centres. It revitalized for example Alert Village, a government programme to promote healthy living that was introduced in 2006. Today, this programme teaches young people how to deal with disaster and trains them in basic skills, including first aid, so that when disaster happens they know how to save themselves and their families.

When Mount Merapi became active again in December 2013 and started to spew ashes and volcanic material, the residents living on the slopes of the volcano immediately gathered at designated assembly points. All people were evacuated on time and were able to go back home after the situation had returned to normal.

source: www.who.int

The Fraser Institute has identified a $1.1 billion loss to Canada's economy resulting from people waiting in line for necessary health care last year.

The study, The Private Cost of Public Queues for Medically Necessary Care, calculates the average value of time lost during the work week for each of the estimated 928,120 patients waiting for surgery at $1,202 per patient.

Keep in mind that the Fraser Institute, which bills itself as "an independent, non-partisan Canadian public policy think-tank," actually tends to lean towards the right of the political spectrum and is not widely acclaimed as a champion for social programs.

But other sources indicate that Canada's health-care system – once among the very best in the world – is not what it could be.

The World Health Organization ranks Canada's health care 30th in the world.

We are ranked behind the United States in patient wait times ... at least, behind Americans who get any care at all, and not taking into account "appropriate care" nuances of the American system.

But there we go again: as soon as Canada's overall health-care quality is brought into question, we compare ourselves with the United States (ranked well behind us at 37th by the WHO), and the conversation is quickly shut down with cries of, "We don't want the American system!"

And nothing changes.

But in the past few decades, at least 29 other countries have moved ahead of us, and many of them make no bones of the fact that they did so by building on – and improving upon – the Canadian model.

It's time we looked beyond our immediate neighbour and took a serious look at what some of our more distant relatives are apparently doing better than we are.

Canada needs to do what they did: look at the best in the world, apply our own ingenuity and tailor to our own needs, and make ours better.

source: www.royalcityrecord.com

Health agencies around the world are working March 24 to raise awareness and action to combat a disease that claims a victim every 18 seconds: tuberculosis.

Just over 8.5 million people a year fall ill with TB, which is exceeded only by HIV/AIDS in the number of lives taken by a disease caused by a single infectious agent, according to the World Health Organization (WHO). About 1.3 million succumbed to the disease in 2012, and it is the leading cause of death for 20 percent of people with HIV/AIDS.

The toll of the disease is high, but it is slowly declining, and WHO reports that the fulfillment of international goals to slow the spread of the disease by 2015 are in sight.

Of the millions who fall ill each year, as many as 3 million are never seen or treated by public health systems because of isolating factors such as poverty, stigma or lack of access to a health facility. Developing better solutions to "reach the 3 million" is the theme of World TB Day 2014, and members of the StopTB Partnership aim to target better TB diagnosis, treatment, prevention and cures to these overlooked patients.

"To reach those most vulnerable, most at risk, those that are poor, weak, scared, stigmatized and alone -- for this, you need additional efforts, you need innovative thinking and, beyond anything else, you need to care," said Dr. Lucica Ditiu, executive secretary of the Stop TB Partnership, in a press release. "I am happy we are having this conversation on reaching, treating and curing everyone with TB at a global level. This is what it is all about."

The partnership is highlighting the missing patients and is proposing solutions that grass-roots organizations, governments and the global community might adopt to better address the problem.

The U.S. Centers for Disease Control and Prevention (CDC), the U.S. Agency for International Development (USAID) and the National Institutes of Health (NIH) are among the many partners addressing what is considered a global health emergency. The U.S. agencies are helping countries with high TB caseloads to expand their basic control programs, invest in research and development, and reach vulnerable populations.

source: allafrica.com