In order to cut premature death rates, the world's politicians need to focus on "simple measures" like anti-tobacco policies, cutting salt levels in food, and improving access to affordable heart disease drugs, according to experts writing in The Lancet today.

The report focuses on preventing 'non-communicable' diseases, or NCDs – i.e. cancers, heart disease, strokes, chronic lung diseases, and diabetes.

Rates of these diseases – which are often linked to lifestyle – are set to soar across the developing world in coming decades.

According to recent estimates, 34.5 million people died from NCDs in 2010, representing two-thirds of the 52.8 million deaths worldwide that year.

In May 2012, the World Health Organisation (WHO) committed to reducing preventable NCD deaths by 25 per cent by 2025.

But in order to make this reality urgent action is needed, the panel of international experts said.

The key is to regard health not as a "goal" of development, but "an instrument to bring it about," according to Sir George Alleyne, Emeritus Director of the Pan American Health Organization and contributor to the report.

"Any realistic attempt to make human development sustainable must take NCDs into account."

That means regulating the marketing of tobacco, alcohol, and 'ultra-processed' food and drinks, said Professor Rob Moodie from the University of Melbourne.

"These companies say they're part of the solution, but the evidence says otherwise. They should have no role in formulating health policy. Put it this way – you wouldn't let a burglar change your locks," he added.

According to the report, there is growing evidence that multinational food, drink and alcohol manufacturers are adopting similar strategies to tobacco industry to undermine public health policies. They should thus be similarly regulated, argue the authors.

Tobacco is the most important preventable cause of cancer, but the disease is also linked to obesity, high alcohol consumption and poor diet.

Policymakers also need to focus on equal access to healthcare, including vaccines and drugs – particularly cheaper generic drugs which could "prevent or treat most NCDs".

Hazel Nunn, Cancer Research UK's head of evidence and information, welcomed the report.

"Cancer is often seen as a disease of the richer world, but just over half of the 12.7 million people diagnosed every year live in less developed countries, and this proportion is rising fast," she said.

"This new report is an important and timely reminder to keep non-communicable diseases high on the global political agenda. Just like the other major NCDs, cancer is a social and economic issue as well as a health issue, and requires strong and joined-up action."

"The Framework Convention on Tobacco Control has given policymakers much-needed guidance in setting national anti-tobacco agendas. This new report suggests that the time may be right to mirror this approach in other areas, particularly alcohol and 'ultra-processed' food and drinks," she added.

(source: www.cancerresearchuk.org)

The three tiers of government in the country have been advised to enroll their citizens into the National Health Insurance Scheme (NHIS) as a means of improving access to quality care in hospital, Senator Isa Zarewa, chairman of a health organization has said.

Senator Isa Zarewa, chairman of the International United Health Care, a Health Maintenance Organisation (HMO) told Daily Trust that most developed countries who are presently medical tourist centres and raking in millions for their countries are able to attend such status because they have well established health insurances.

Speaking during a training organized by the organization to update its staff on best practices abroad on how to provide better services to their client at the Reiz Hotel, Zarewa said that the HMO was looking at cascading into community health insurances to assist those at the rural areas.

He added that if the NHIS is adequate financed by the government, or even people it would go along way to do away with out of pocket spending, which is gradually collapsing the system

He however warned that the HMO would always put their client's health first and deal with hospitals that fail to compel with the terms of agreement and mis management the needs of the patients.

Earlier the managing director of International United Health Care, Dr Kolawole Owoka said that though the health sector is fragmented, with the rich travelling abroad for medical treatment, with the poor making do with what the country has to provide, NHIS according to him can bridge the wide gap in accessing health care.

He added that the organization is bracing up to assist the government achieve universal coverage which he said would improve the health indices.

He advised that to achieve universal coverage, Nigeria as a developing nation has to borrow a leaf out of great developed countries and look at how they operate their health insurances, with minority group subsiding the bills of the majority.

(source: allafrica.com)

A website providing a directory of medical services and other resources for people living with HIV/AIDS in Indonesia was recently set up to help patients more easily access treatment and information about the disease.

"We decided to set up this portal and mobile application we call 'AIDS Digital' because there has not been a comprehensive service that could facilitate the AIDS-affected community or the public in general who want to know more about HIV testing, antiretroviral [therapy and drugs], reference hospitals or any other sexual transmitted disease," Aditya Wardhana, the executive director of the Indonesia AIDS Coalition, told the Jakarta Globe on Saturday.

Aditya said even with the growth of the Internet and access to it, proper information about HIV/AIDS in Indonesia was scarce. Even those able to access the information found it difficult to ask further questions because few websites providing information about HIV/AIDS were interactive.

Users are able to submit questions about HIV/AIDS and receive responses via the website.

"Most of the time the dissemination of information about HIV/AIDS was done from mouth to mouth," Aditya said. "This method has failed to break the negative stigma and taboo surrounding the infection itself."

AIDS Digital, which can be accessed at www.aidsdigital.net, offers directories of health facilities providing sterile needles, methadone therapy and antiretroviral drugs, as well as the addresses of reference hospitals and nongovernmental organizations that provide counseling and advocacy for HIV/AIDS patients. It also contains comprehensive information about HIV/AIDS, prevention programs and discussions aimed at debunking myths about the disease.

The website also allows users to rate the services provided by health facilities.

"With the satisfaction survey, we hope we can push the health service in Indonesia to improve," Aditya said.

"We hope AIDS Digital can be a private space for the AIDS-affected community so they can access the service they need without having to be burdened by shame or fear of people finding out about their status," he added.

The number of Indonesians living with HIV was around 370,000 in 2011, according to UNAIDS.

About $69 million was spent in 2010 to prevent and treat AIDS in Indonesia, according to the National AIDS Commission, an increase of around $13 million since 2006. More than half of that comes from international sources of funding.

(source; www.thejakartaglobe.com)

More coherence is needed between public health, intellectual property (IP), and trade policies in order to advance innovation and improve access to medicines, according to a joint report released by the WTO, the World Health Organization (WHO) and the World Intellectual Property Organization (WIPO) on Tuesday.

The study, entitled "Promoting Access to Medical Technologies and Innovation: Intersections between Public Health, Intellectual Property, and Trade," was designed to bring together the three organisations' respective areas of expertise with the goal of better informing policy-making decisions, especially in developing countries.

Coherence is key, WTO, WIPO, WHO chiefs say

In recent years, the role of the IP system in fostering medical innovation and its potential impact on medicines' availability have been the subject of extensive discussions - and controversy - at the different organisations.

"The IP system is not an isolated specialist domain, nor yet a monolithic barrier to public health; instead, IP is an element of a complex set of policy tools required to resolve global problems," WTO Director-General Pascal Lamy explained.

Coherence between health policies, IP rules, and trade policy is therefore "key" toward ensuring that sustainable solutions are found for issues involving access to medicines and medical technologies, the WTO chief added. Along with medicines, medical technologies can also include vaccines and medical devices.

Indeed, the mission of IP is to find an equilibrium point among all interests that surround the process of knowledge production and distribution, as well as "translating intellectual assets into productive assets," WIPO Director-General Francis Gurry told the audience.

Developed countries have traditionally argued that making patent laws less stringent could hinder innovation on developing medicines and medical technologies; meanwhile, developing countries have long called for more flexibilities and exceptions to have more policy options available in this area.

The study therefore calls for appropriate and creative patent licensing strategies to ensure that drugs and medical technologies are made both affordable and available in poorer countries. While the study also points out the importance of the patent system for the pharmaceutical sector, it identifies alternative incentive mechanisms that seek to enable the development of new products for treating neglected diseases.

The organisations also list various flexibilities aimed at safeguarding the public interest that are already available in the international IP regime. In this regard, WHO Director-General Margaret Chan indicated the need to discuss ways to promote drug availability for treating non-communicable diseases - such as anti-cancer medicines - specifically mentioning the recent trend of issuing compulsory licenses to allow the production of life-saving generics. Chan stressed that generics must be brought quickly into the market, as delaying their entry "hurts public health."

She also suggested that attention should be given to the request by least developed countries (LDCs) to extend the transition period for applying the WTO's Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), which is set to expire in July 2013. (See Bridges Weekly, 14 November 2012)

"I fully respect the sovereignty of the multilateral systems in WTO and WIPO. From a public health perspective, an extension of the transition period is worth consideration," Chan said.

Impact of trade policies on access to medicines

The study also highlights trends in trade of health-related products, and how certain trade policies can help or hinder access to medicines. For instance, high tariffs in some countries can have negative implications for this area.

The study also considers competition and procurement policies that could be beneficial in promoting innovation and availability of medical technologies. For instance, competition policies "can serve as a corrective tool if and when IP rights hinder competition and thus constitute a potential barrier to innovation and access."

With regard to procurement policies, the study indicates that open and competitive tendering - such as what the WTO's plurilateral Government Procurement Agreement aims to ensure among its parties - is particularly important in increasing access to medical technologies at a time when governments are facing intense budget constraints.

(source: ictsd.org)

JAKARTA : In Indonesia, thousands of workers took to the streets in five major cities including the nation's capital Jakarta on Wednesday.

Those in Jakarta, who were mostly from the Federation of Metal Workers' Union, made several demands including having universal healthcare and their right to protest.

They are demanding that President Susilo Bambang Yudhoyono issue a presidential decree that would lead to universal health insurance for all Indonesians by 2019.

This health insurance programme has been approved and will start as of 2014 but the Presidential decree required has yet to be issued.

Said Iqbal, President, Federation of Indonesian Metal Workers' Union, said: "If a government regulation and Presidential decree, which was supposed to be issued last November, is not introduced then steps for universal healthcare cannot begin. That's why the government is obliged to introduce the necessary regulations by late February, which includes guaranteeing that employers pay for their workers' insurance premium fees and that the poor will be able to receive government's healthcare."

One of the other demands made is a guarantee for a pension fund for labour workers from 2015

The workers are also calling for the provincial government to raise the number of components in the reasonable cost index from around 60 to 80 components.

This index is used as a benchmark to determine minimum wage increases for next year.

The workers are also objecting to two bills on national security and social organisation being deliberated in Parliament

They claim that if these two bills are passed then it will curb their right to protest in the streets citing security reasons.

If their demands are not met, the next major rally will be on 26 February by the Indonesian Labour Workers Association, the biggest labour union in Indonesia.

The union has warned that if its demands are not met by the end of April, then there will be an all out labour rally across the nation on Labour Day, 1st May.

(source: www.channelnewsasia.com)

PARIS: Africa, India and other developing countries are awash in fake or sub-standard drugs for tuberculosis, fuelling the rise of treatment-resistant strains of TB, according to a survey published on Tuesday.

Investigators in the United States asked local people in 19 cities in 17 countries to purchase isoniazid and rifampicin, the frontline antibiotics for TB, from a private-sector pharmacy.

The samples were then examined by chromatography, a technique that detects chemical signature, for their active ingredient.

They were also tested for disintegration, to see if they properly broke up in water at body temperature within 30 minutes.

Out of 713 samples, 9.1 percent failed these basic quality control tests, according to the probe, published in the International Journal of Tuberculosis and Lung Disease.

Around half of the failed samples had zero active ingredients, "making them likely to contribute to drug resistance," it said.

Resistance to TB drugs develops when treatment fails to kill the bacteria that causes it -- either because the patient fails to follow their prescribed dosages or, as in this case, the drug doesn't work.

It can also be contracted through rare forms of the disease that are directly transmissible from person to person.

Dud drugs were manufactured by legitimate companies and criminal fraudsters, said the report.

The pharmacies where the drugs were purchased were in Luanda, Angola; Sao Paulo, Brazil; Beijing, China; Lubumbashi, Democratic Republic of Congo; Cairo, Egypt; Addis Ababa, Ethiopia; Accra, Ghana; Chennai, Delhi and Kolkata, India; Nairobi, Kenya; Lagos, Nigeria; Moscow, Russia; Kigali, Rwanda; Dar-es-Salaam, Tanzania; Bangkok, Thailand; Istanbul, Turkey; Kampala, Uganda; and Lusaka, Zambia.

The failure rate was 16.6 percent in Africa, 10.1 percent in India and 3.9 percent in Brazil, China, Thailand, Turkey and Russia.

Nearly nine million people around the world have TB, including more than 400,000 with a multidrug-resistant form of the disease, according to estimates for 2011 compiled by the World Health Organisation (WHO).

TB is one of the world's deadliest diseases. It is spread from person to person through the air and usually affects the lungs, but it can also affect other parts of the body such as the brain and kidneys.

Read more: http://www.dailystar.com.lb/News/Health/2013/Feb-05/205064-third-world-is-swamped-with-fake-tb-drugs-study.ashx#ixzz2K4wlmypt

(source: www.dailystar.com.lb)

This month the Health Council of Canada published the 2012 Commonwealth Fund International Health Policy Survey of Primary Care Doctors. This informative study is based on a survey of more than 2,000 primary health care workers across the country.

It focuses on how front liners perceive the system (Does it require minor or major change? Do patients get too much or too little care? Can they get diagnostic tests when they need them?) and how they themselves operate (Do they make home visits? Prescribe electronically? Monitor their own performance against targets?) It provides a fascinating insight not just into how we are doing, but also into how we are doing relative to other countries. Sadly, the answer is "not that well."

Canada's health system sits more or less in the middle of the pack on physicians' perceptions of how much change is required: 40 per cent of respondents say the system needs "only minor changes" and our doctors themselves are happy (82 per cent say they are satisfied or very satisfied with practising medicine).

But does their happiness come at the expense of patient care? The disparity between physician satisfaction and the measures in the survey that would seem to translate directly into patient satisfaction, is telling.

As the report notes: "Compared to physicians in nine other countries, Canadian primary care physicians are the least likely to routinely provide same-day or next-day appointments (47 per cent). They are also among the least likely to make home visits (58 per cent) or have after-hours arrangements so that patients can see a doctor or nurse without going to a hospital emergency department (46 per cent)." But doctors themselves may be oblivious to this, because Canadian primary care physicians are also among the least likely to work in practices that regularly review clinical performance against targets (41 per cent average, varying between 62 per cent for B.C. and 19 per cent for Quebec).

Overall, then, this is not an uplifting survey. It finds that "In overall national performance, Canada shows no relative improvement in any areas of access to care ... since 2006."

Canadians are always wont to compare our system to the U.S. This makes sense, but only in geographic terms. There are numerous examples of mixed public-private systems around the world that exhibit substantially greater cost effectiveness and better medical outcomes than our own. None is perfect and all systems struggle to rein in costs, but should we not be learning from elsewhere? And isn't the Health Council survey a good place to start identifying our deficiencies?

At Canada 2020, we have been gathering information on an alternative public-private hybrid model being tested in the U.K. (a country in which 95 per cent of primary care workers say their patients can get after-hours service outside a hospital emergency department and where 96 per cent of physicians regularly review clinical performance against targets).

In 2012, The Circle Partnership was awarded a 10-year contract to manage a publicly funded, full-service hospital in Huntingdonshire. The National Health Service continues to employ most of the hospital's staff. Health care remains free and universal at the point of delivery, but private-sector incentives have been introduced. Doctors, nurses, and other Circle employees collectively own 49.9 per cent of the company, while the rest is owned by a group of hedge and venture capital funds.

The model is relatively simple: if efficiencies by Circle yield a surplus at Hinching-brooke Hospital, profits will be shared by the hospital, the NHS, and Circle. If the hospital continues to post a deficit under Circle's management, Circle will earn nothing and has agreed in its contract to be responsible for the first $8 million of fresh debt.

It is too early to judge Circle's success. On the one hand, the hospital's emergency room, which regularly failed to meet targets in the past, was ranked first of 46 hospitals in eastern England after six months under Circle's administration. Monthly targets for cancer treatment, which had last been met in June 2010, were being fulfilled every month and the length of a patient's stay after hip or knee surgery fell from an average of 5.6 days to 2.6 days, allowing for faster turnaround of rooms. On the other hand, Circle has yet to demonstrate its ability to keep costs under control (although it is early days yet). The hospital's losses reached $6.5 million within eight months, just over double the $3 million of debt that Circle had predicted for the hospital by that point.

Here in Canada, no legislation prevents the introduction of private health care administration. What's more, our current system should lend itself well to the transition because Canadian primary-care doctors are already paid under a fee-for-service system, rather than earning a fixed salary.

It seems, though, that the largest roadblock to introducing a similar model to Canada lies in public resistance to change. Opposition to any linkage between the private sector and health care remains strong (back to that American comparison problem) and a number of Canadian facilities that have incorporated private incentives have been closed, despite their success (for example the Canadian Radiation Oncology Services clinic in Ontario and a private clinic at Montreal's Sacré-Coeur Hospital).

But aren't we Canadians open-minded people? Surely we can open our minds to alternative ways to deliver universally accessible publicly funded health services. The Circle model may not be the perfect solution, but it is well worth watching from our shores if only for the reason that health care improves most when the medical community does what it does best: experiments.

Diana Carney is vice-president of research at Canada 2020, an independent, progressive think-tank. Arianne Charlebois is a research intern with Canada 2020.

(source: www.faceoff.com)

Representatives from Ministries of Finance and Health, national health insurance authorities and development partners, as well as experts and practitioners from Asia and Africa are to meet in South Africa next month at a forum on the role of health insurance in achieving universal health coverage and social health protection.

The forum, entitled "Achieving Universal Coverage Through Health Financing Reform", is organized by the African Development Bank (AfDB), in collaboration with the German International Cooperation (GTZ), the International Labour Organization (ILO) and the World Health Organization (WHO), and in close consultation with the Government of the Republic of South Africa.

The forum, which takes place from March 11-14, 2013 in Centurion, South Africa, is expected to attract an estimated 60 representatives from 16 African and four Asian countries. It aims to facilitate knowledge exchange between African and Asian countries on building coherent and sustainable health financing systems (prepayment, pooling and strategic spending) that are geared to achieving universal health coverage.

Focusing on the Southern African region, the forum will explore in particular the role of extending coverage of pooled financing mechanisms (often under the label of "health insurance"), for moving closer to universal health coverage. It will discuss key aspects, the potential as well as the challenges and limitations of different approaches to revenue contribution, pooling, and purchasing in closing healthcare coverage gaps.

At the July 2012 Conference on Value for Money Sustainability and Accountability, African Ministers of Finance and Health acknowledged that millions of Africans suffer severe economic consequences due to the need to pay for out-of-pocket healthcare. The financial strains on people due to out-of-pocket spending aggravate inequities and impede sustainable social and economic development. Furthermore, millions more do not even seek the care they need due to the high costs of accessing and using it.

The financial risks that out-of-pocket expenditure presents can be diminished through prepayment, pooling and strategic spending of resources. A number of countries in Sub-Saharan Africa are currently reforming their national health financing systems with a view to achieving universal health coverage and social protection for all.

The main outcome of the exchange will be a set of recommendations for country health financing reform as well as the identification of where development partners can support southern African countries in their efforts towards universal health coverage.

More South-South exchanges such as this one are expected as countries continue to collaborate and share experiences.

(source: allafrica.com)