Kuala Lumpur - The Health Ministry plans to have 175 1Malaysia clinics by year-end due to the high demand, said Minister Datuk Seri Liow Tiong Lai.

"The clinics have benefited some five million patients so far. The response has been very encouraging.

"There are currently 119 1Malaysia clinics in operation nationwide while 56 more are in various stages of implementation," he said at the launch of the 1Malaysia clinic at the Danau Kota flats here yesterday.

Liow said they planned to expand the clinics' services to include healthcare for mothers and children beginning next year.

The 1Malaysia clinics, he said, would make it easier for patients to seek treatment as they were open from 10am to 10pm and located near residences.

Patients, he said, could seek treatment at the community-based clinics but needed to go to a hospital for serious ailments.

The clinics offer treatment for minor ailments such as cough, flu and fever, basic dressings, sugar and urine tests as well as health advice, among others.

Liow later attended the Hari Raya open house organised by Wangsa Maju MCA division chief Datuk Yew Teong Look's service centre. Yew was formerly the Wangsa Maju MP.

(Asiaone.com)

The Health Ministry has launched an online distance-learning course for field epidemiologists to help them improve their knowledge about epidemiological investigations, which might be useful when dealing with unexpected public health crises.

The 2012 Field Epidemiologist Training Program (PAEL) offers participants a unique online training methodology in which they can study from anywhere in the country.

"Many health workers have limited chances to attend training courses as they live in remote areas, precisely those places that are classified as areas with serious health problems," Sulistiono, the Health Ministry's human resources, learning and training center head, said on Friday.

Field epidemiologists have the responsibility of investigating unexpected health problems that need immediate intervention.

Some 140 epidemiology field assistants are currently attending the online PAEL pilot program in seven provinces: Central Java, East Java, Jakarta, North Sumatra, South Sulawesi, South Sumatra and West Java.

The program, developed by the ministry in collaboration with the Education and Culture Ministry's Information and Communications Technology Center (Pustekkom), began on Sept.11 and will run for the next 31 days.

Sulistiono hopes that such trainings would be developed further in the future. "The e-learning can be done from home, which means we can be more efficient in our spending," he said.

(Thejakartapost.com)

WASHINGTON — The American medical system squanders 30 cents of every dollar spent on health care, according to new calculations by the respected Institute of Medicine. But in all that waste and misuse, policy experts and economists see a significant opportunity — a way to curb runaway health spending, to improve medical outcomes and even to put the economy on sounder footing.

"Everybody from Paul Krugman to Paul Ryan agrees it is essential to restrain costs," said Dr. Mark D. Smith, the president of the California HealthCare Foundation and the chairman of the committee that wrote the report, referring to the liberal economist and Op-Ed columnist for The New York Times, and the conservative Wisconsin congressman who is Mitt Romney's vice-presidential running mate. "The health care industry agrees, too."

The Institute of Medicine report — its research led by 18 best-of-class clinicians, policy experts and business leaders — details how the American medical system wastes an estimated $750 billion a year while failing to deliver reliable, top-notch care. That is roughly equivalent to the annual cost of health coverage for 150 million workers, or the budget of the Defense Department, or the 2008 bank bailout.

The institute's analysis of 2009 data shows $210 billion spent on unnecessary services, like repeated tests, and $130 billion spent on inefficiently delivered services, like a scan performed in a hospital rather than an outpatient center.

It also shows the health care system wasting $75 billion a year on fraud, $55 billion on missed prevention opportunities and a whopping $190 billion on paperwork and unnecessary administrative costs. The Institute of Medicine is an independent adviser to the government and the public, and part of the National Academy of Sciences.

The report depicts a system that saves lives in miraculous fashion, but is also expensive and outmoded and in some cases downright Kafkaesque.

"If banking were like health care, automated teller machine transactions would take not seconds but perhaps days or longer as a result of unavailable or misplaced records," the report said. "If home building were like health care, carpenters, electricians and plumbers each would work with different blueprints, with very little coordination."

Along with the squandered money there is a human toll, the report said, as medical errors and inefficiencies mean that doctors fail to deliver the best and most timely care to patients.

"If the care in every state were of the quality delivered by the highest-performing state, an estimated 75,000 fewer deaths would have occurred across the country in 2005," the report said.

But the report — and independent health care experts and economists analyzing it — identified an opportunity in that $750 billion of wasted health spending. If hospitals, doctors and insurers could wring even a fraction of that money out, it would help to bend the so-called cost curve of runaway health inflation while improving patient outcomes.

The point of the report is that "Americans should expect to get and should demand to get better value for their health care dollar," Dr. Smith said.

"That money is not only not buying anything," said David Cutler, the Harvard health economist. "It is actually a sign of poor care. A lot of cost reductions, if we do them the right way, would mean improved health, not worse health."

Professor Cutler gave as an example rules to make sure that doctors do not perform inductions for otherwise healthy pregnant women before 39 weeks of gestation. It would both save money and improve health outcomes by reducing the rate of Caesarean sections, he said.

The report gives recommendations intended to reduce spending and improve care: ensuring doctors work in teams and share information; making prices and costs transparent to consumers; rewarding doctors for outcomes, not procedures; ensuring all doctors use the best-tested practices, and identifying and correcting errors among them.

The report also detailed instances of health care providers offering such smarter care: hospitals preventing re-hospitalizations, upgrading their records systems and cutting out ineffective therapies, for example.

Some health economists and policy experts believe that political changes and financial pressure have already spurred insurers and health care providers to start squeezing out costs, contributing to the slowdown in health spending growth seen in the past few years.

"We're starting to see some very early results," said Wendy Everett, the president of NEHI, a health care research group based in Cambridge, Mass.

She said she expected to see more and more adoption of best practices in the next few years, spurred by President Obama's Affordable Care Act, other changes to Medicare and Medicaid and a recognition among doctors and insurers that the current trajectory of health care spending is unsustainable.

"This train's coming much faster than we thought," Ms. Everett said. She guessed that within a decade providers being paid for the quality, not quantity, of care would be "the norm."

(www.Nytimes.com)

New York, NY, United States (IRIN) – Dengue fever is classed by the World Health Organization (WHO) as a "major international public health concern". WHO estimates that it infects 50-100 million people a year; it is a leading cause of death among children in Asia and Latin America, and it is now spreading outside its traditional heartlands to Africa and the Middle East.

But dengue is difficult to deal with. There is no cure, only treatment for the symptoms. And although there are effective vaccines against related viruses, like yellow fever and Japanese encephalitis, no one has yet succeeded in making a safe, effective vaccine against dengue.

Now a team of researchers working with the French drug company Sanofi Pasteur has carried out a randomized trial of a possible vaccine, involving more than 4,000 schoolchildren in northern Thailand, and have produced some interesting results. Their vaccine was only partly effective but the team's findings – reported in the British medical journal, the Lancet – suggest that the development of a useful vaccine is getting closer.

Derek Wallace of Sanofi-Pasteur, one of the authors of the report, hailed their results as an important step. "Our study constitutes the first ever demonstration that a safe and effective dengue vaccine is possible," he says. "Further trials [of the vaccine] are currently under way in a number of different countries, and we hope that the positive results of this trial will be confirmed by these larger studies."

The trial took place in Thailand's Muang District, based at Ratchaburi Regional Hospital, and involved researchers from Bangkok's Mahidol University. Children aged 4-11 from 35 local schools were enrolled in the trials. Two-thirds of them were given three doses of the vaccine, known as CYD-TDV (a recombinant, live, attenuated tetravalent vaccine, based on yellow fever 17D vaccine strain, produced in Vero cells). The control group received either rabies vaccine or a placebo.

The children were vaccinated three times, at six-monthly intervals, and the researchers looked at the presence of dengue antibodies in their blood, as well as checking all cases of fever, mild or serious, and recording which were due to dengue.

The results were mixed. While the vaccine appears to be safe and well tolerated, it had only a limited effect. It gave useful protection against three strains of the disease, those known as DENV 1, 3 and 4. But although the vaccinated children produced antibodies to DENV 2, they still caught the disease just as often as the children in the control group. And unfortunately DENV 2 is the most common strain of dengue fever in northern Thailand.

Caveats

Scott Halstead of the International Vaccine Institute in Seoul, points out that even these results were made less useful by the fact that they did not test the vaccine on teenagers, who are more likely to get the severe form of the disease. He said: "Results from this vaccine trial provide hard evidence of protection against DENV 1, 3 and 4 mild disease but insufficient data to calculate vaccine efficacy rates for severe disease. Future dengue vaccine trials should provide robust evidence of efficacy against severe disease by selecting populations weighted to assure inclusion of sufficient numbers of at risk children."

Bill Messer, clinical assistant professor at the Division of Infectious Diseases in the University of North Carolina School of Medicine, is blunter, pointing out that Sanofi Pasteur has been trying to refine the vaccine for the past decade (it started presenting papers on it in about 2001) but that the vaccine still cannot produce a "robust" response.

"This [study] is an encouraging first step, but far from where we need to be. It did not show the vaccine can prevent severe cases. That is an important endpoint [for a dengue vaccine]. You need to show recipient populations protection against severe dengue in order to encourage [vaccination]," he said.

While most dengue patients do not have symptoms or only mild pain and a rash, up to 10 percent develop a lethal "severe" form of the disease (previously known as dengue haemorrhagic fever). Only five children in the study had severe dengue, too few to analyse, a limitation the authors noted was being corrected in ongoing studies with 30,000 adults and children in dengue-endemic countries.

Messer also said the number of people tested thus far in Thailand is insufficient to prove the vaccine will not cause severe dengue. Health experts have expressed concern that complications from a dengue vaccine may result in infection rather than confer protection.

Despite some positive results from the trials, it seems that a dengue vaccine is still a long way off.

(gantdaily.com)

Bangkok, Thailand (IRIN) – Most countries in Asia have yet to make the rotavirus vaccine part of their national immunization programme (NIP), despite a World Health Organization (WHO) recommendation to do so.

"Timely vaccination with one of the two effective rotavirus vaccines [Rotarix and Rotateq] can prevent many cases of [rotavirus] illness and hospitalizations," WHO's Manila office said in an email to IRIN on 7 September. "WHO recommends the inclusion of rotavirus vaccine in the national immunization schedules of all countries."

According to WHO, rotavirus is the most common cause of severe diarrhoeal disease in young children, with more than 500,000 children under the age of five dying worldwide each year. Highly contagious, the virus causes vomiting and severe diarrhoea that can lead to dehydration and potential death.

Children aged six months to two years are particularly vulnerable to infection. Worldwide, rotavirus accounts for 37 percent of all diarrhoea deaths in children under five with 95 percent of those deaths occurring in developing countries.

While the virus is treatable by providing fluids and salts, health experts note that it has a devastating and deadly impact in areas where people cannot access medical care. There are no antibiotics or any other drug to fight the infection and since 2009 WHO has recommended the global use of the rotavirus vaccine.

"For rotavirus vaccine the main aim is to prevent or reduce the severity of the first one or two infections in young children," Tony Nelson, professor of paediatrics at the Chinese University of Hong Kong and member of the Rotavirus Organization of Technical Allies (ROTA council), told IRIN. "It is these first infections that are the most severe and most likely to cause life-threatening dehydration."

The international health NGO PATH reports that in Asia 42 percent of all hospital admissions of children under five with diarrhoea are the result of rotavirus, while 188,000 children under five die each year.

"As many of these deaths and admissions could be prevented by vaccination, it is sad that very few countries in Asia have announced plans to include rotavirus vaccines in their NIPs," Nelson said.

As of September 2012, 41 countries worldwide have introduced rotavirus vaccines in their NIPs. Four African countries – Botswana, Ghana, Rwanda and Sudan – have fully introduced the oral vaccine in their NIPs, while South Africa and Zambia introduced rotavirus vaccination on a regional basis.

However, only two countries in Asia – Philippines and Thailand – are vaccinating (or are about to) children against rotavirus: "Price continues to be an important barrier to introducing rotavirus vaccine," WHO explained.

In July, Philippines started vaccinating an estimated 700,000 children each year aged 1.5-3.5 months from the poorest communities.

In the same month Thailand announced it will vaccinate regionally, but has yet to provide an actual launch date. (gantdaily.com)

Health ministers from the 11 member states of the World Health Organization Southeast Asia Regional Office (WHO SEARO) agreed on Tuesday to adopt the Yogyakarta Declaration on Aging and Health, and committed to improving national responses to the health of aging populations.

The declaration comes at an important juncture in history as 142 million people or 8 percent of the population of the region are above the age of 60. The figure is estimated to double by 2025 and treble by 2050.

"The WHO follows a life-course approach to promoting healthy, active aging. People who get the right start in life, follow healthy lifestyles and take good care of their health can expect to remain active during their eighth, ninth and even 10th decades of life," WHO director general Margaret Chan said.

The adoption was made during the 30th health ministers meeting and the 65th session of the WHO regional committee for Southeast Asia in Yogyakarta, opened by Indonesian Vice President Boediono on Tuesday.

WHO SEARO groups together Bangladesh, Bhutan, South Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor Leste.

The declaration underscores concern that the economic effects of aging will impact on health care and social support systems and will require the attention of policy makers, NGOs and the private sector.

The ministers also recognized that healthy aging should optimize opportunities for the physical, social and mental health of older persons to enable them to take an active part in society and to enjoy an independent life without discrimination.

Health Minister Nafsiah Mboi said in her remarks at the meeting that the declaration "will force governments of [Southeast Asia region] member states to commit on building partnerships among various stakeholders to strengthen health qualities and services for aging populations."

Providing an example, Nafsiah said that Singapore had implemented a policy that prioritized housing facilities for families who were willing live together with their respective aged parents.

"In this case, each of the states has to look for the right policy for its respective country," she said. (Thejakartapost.com)

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

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

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

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

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

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

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

Helping the "Three No" people

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

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

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

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

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

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

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

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

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

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

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

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

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