In a little more than a month's time the world will mark the first anniversary of the adoption of the Sustainable Development Goals — the first-ever global to-do list for a fairer, safer and healthier world by 2030.

Much has been written about the expanded scope of the goals relative to the Millennium Development Goals, and the complex links that bind them all together. Among the health-related targets, some represent the unfinished business of the MDG era, and some are new targets that reflect changing disease patterns and the challenge of aging populations.

But none are more significant than target 3.8: achieving universal health coverage. The UHC target is the linchpin of the health-related SDGs; the one target that, if achieved, will help to deliver all the others by providing both population and person-centered high-quality services that are free at the point of delivery and designed to meet the realities of different people's lives.

Of course, UHC is not a new concept, but its inclusion in the SDG agenda is a significant acknowledgment by the nations of the world that progressing toward UHC will not only improve the health of millions, but will also contribute to reaching many of the other SDGs. Over the past five years or so, more than 70 countries have asked the World Health Organization to help them progress toward UHC.

Moving toward UHC

One important step is to agree on how to measure it. Two indicators have been selected for UHC: one that measures the level of coverage in a population by tracking access to a set of eight core health services, and another that measures the extent to which people are exposed to financial hardship through out-of-pocket expenditure on those services.

Both are important because they capture the twin imperatives of UHC: that people and populations receive the health services they need, without facing financial hardship. WHO estimates that about 150 million people around the world suffer financial catastrophe annually from out-of-pocket expenditure on health services, while 100 million people are pushed below the poverty line.

There is no one-size-fits-all approach to achieving UHC. There are, however, several common unavoidable truths that we must all face. Aging populations and the burgeoning burden of noncommunicable diseases present unique challenges that will require all countries to find innovative ways to reshape their health systems.

One of the first requirements will be a radical transformation of the health workforce. The global economy is projected to create demand for 40 million new health workers by 2030, but most of those jobs will be created in the wealthiest countries. Low and lower-middle income countries need 18 million more health workers if they are to achieve UHC. Without urgent action, that mismatch will widen.

A view to future investment

The High-Level Commission on Health Employment and Economic Growth, chaired by President François Hollande of France and President Jacob Zuma of South Africa, will next month deliver a set of recommendations on how to address this challenge. Among them will be a call for countries to see their health workers as an investment, instead of a cost. Investments in the education, training, work conditions, financing and deployment of health workers will pay handsome dividends, not only for the health of populations, but for economies, health security and gender equity.

A second major challenge is the ever-increasing price of medicines. Recently-approved drugs for cancer and hepatitis C hold enormous promise, but come with eye-watering price tags that put them out of reach for most of the people who need them.

A study published in PLOS Medicine at the end of May found that, after adjusting for average 2015 exchange rates and purchasing power, the cost of treating the entire hepatitis C-infected population in each of 30 countries would range from 10.5 percent of total pharmaceutical expenditure in the Netherlands to 190.5 percent in Poland. In 12 countries, the price of a 12-week course of sofosbuvir (the medicine concerned) was equivalent to one year or more of the average annual wage, ranging from 0.2 in Egypt to 5.3 in Turkey.

Last year, WHO included several new treatments for cancer and hepatitis C on its "essential medicines list," a statement that innovative technologies with the potential to cure or significantly alter the course of deadly diseases are not luxury items for the privileged few; they are public goods to which access must be equitable.

The difficulty lies in assessing what represents a fair profit margin for pharmaceutical companies, especially when returns for shareholders are prioritised over access to lifesaving medicines. That assessment is hindered by the lack of transparency around exactly how the prices of medicines are set. Research and development investments are clearly needed, but their real cost is unclear. Information on the patent status of essential medicines is also not easy to obtain, making it difficult for countries to assess whether they can procure generic medicines or produce them locally.

To that end, WHO is planning to convene governments, patient groups and industry stakeholders to discuss principles for a fair pricing model that can affordably deliver the medicines needed by patients while keeping companies interested in developing new and better treatments and producing generic treatments. This may require reconsideration of the need for transparency, full understanding of what it costs to develop a new product, as well as understanding the minimum profit needed to keep production going.

Achieving UHC, like all of the SDGs, is a challenge for all countries, rich and poor. All nations will have to take steps to reform their health workforce and address the affordability of medicines. No one can afford a business-as-usual approach. Nor does anyone pretend that UHC can or will be achieved with a snap of the fingers. The challenges are serious, although not insurmountable. But if the world leaders who signed up to the SDGs are to deliver on their promises, they must be prepared to take bold action to deliver on UHC.

https://www.devex.com/

BEIJING, A new report says China can offer better health care for its citizens at affordable costs if it restructures its delivery model to focus on providing integrated primary care for its rapidly aging population, and reforming public hospitals so they mainly treat complex and acute cases.

Switching to "people-centered, integrated care" would keep routine patient care outside of hospitals and help China cut down on health costs by as much as 3 percent of its gross domestic product (GDP) by 2035, according to the report conducted by the World Bank and the World Health Organization, the Ministry of Finance, the National Health and Family Planning Commission, and the Ministry of Human Resources and Social Protection of China. The savings, according to Bank estimates, is projected to be in the hundreds of billions of dollars annually.

Business as usual, however, would increase health spending by 8.4 percent a year from 2015 to 2020, faster than the projected GDP growth of 6.5 percent a year.

"Decades ago, China's innovations in health such as barefoot doctors and cooperative health care showed the world it was possible to improve the health and greatly increase the life expectancy for hundreds of millions of people," said World Bank Group President Jim Yong Kim. "Today, China can once again lead the way with cutting-edge primary health care reform that puts the patient first and shifts away from expensive hospital care that often does little to improve the health of people. If China institutes these reforms, we believe it will improve the health care system for all Chinese—or one in every six people in the world."

The report, Deepening Health Reform in China, is the most comprehensive report so far about China's health reform. Two years in the making, it is based on 20 background studies, more than 30 case studies, visits to 21 provinces in China, and a series of technical workshops with a diverse team of policy makers, practitioners, researchers and academicians from all three partners.

Success and challenges in China's health care systems

The report comes as the Chinese government embarks on health reforms under the 13th Five-Year Development plan, including legislation that would set parameters of the health sector.

Its recommendations are built on China's impressive success in health care over the last two decades. With massive investments in health infrastructure, the country achieved near-universal health insurance coverage at an unprecedented speed, with more than 95 percent of its population covered by 2011. This helped reduce child and maternal mortality rates; a child born in China today can expect to live more than 30 years longer than he would 50 years ago.

But China's health costs have been growing because of rising incomes and expansion of health insurance to almost all citizens. After lifting more than 600 million people out of poverty amid double-digit growth in the last three decades, China now faces slower growth and emerging challenges common to a better-off society.

China faces emerging challenges to meet the healthcare needs of its citizen, due to a rapidly aging society and the increasing burden of non-communicable diseases, such as cancer and heart disease. There are now 140 million people older than 65 years in China, and that is expected to increase to 230 million by 2030. Infectious diseases have been replaced by non-communicable diseases as the greatest health threat, accounting for more than 80 percent of the 10.3 million deaths every year. Those diseases are exacerbated by high-risk behaviors such as smoking, sedentary lifestyles and alcohol consumption, as well as environmental factors such as air pollution. At the same time, with higher economic growth and personal incomes, people are demanding more and better health care.

That has put pressure on the health care system. According to the report, health gains have slowed, but healthcare spending has been growing at a rate of 5 to 10 percentage points higher than GDP growth since 2005. Out-of-pocket expenditures have eased significantly in recent years, but at 32 percent of total spending in 2014, the rate is still higher than the average of 21 percent among high-income economies.

Recognizing the challenges, Chinese Premier Li Keqiang agreed with the World Bank Group president and World Health Organization director general in 2014 to prepare this study.

The report details a series of recommendations on the practical and concrete actions required to build a healthcare system for the future, through improved service provision and the creation of a financial and institutional environment for the improved care.

People-centered integrated care

At the core of the report's recommendations is the full adoption of a people-centered integrated care model. The bedrock of this type of model is a strong primary care system that is integrated with more advanced care, especially for patients with chronic illness such as cancer and diabetes.

Another recommended way to improve to China's healthcare system is to reform public hospitals so they are no longer a one-stop shop for all health services, but instead are used for more acute care with primary care provider covering routine care.

A more effective system would also change incentives for providers so they are rewarded for good health outcomes for patients instead of for the volume of care, which is a major driver of health costs.

The report recommends boosting the status of primary care providers so they are better paid and supported, to ensure a competent health workforce that people can trust.

It also supports allowing qualified private health providers to compete on a level playing field with the public sector to deliver cost-effective services.

And finally, the report suggests that a national authority to oversee quality improvements across the system could be considered by China.

The report urges China to incorporate the proposed changes in a coordinated and deliberate manner. It said it will likely take about 10 years for China to fully implement the proposed reforms.

http://www.worldbank.org

Indonesian President Joko Widodo signed Presidential Instruction No. 6/2016 on the Acceleration of Development of the Pharmaceutical Industry and Medical Devices on 8 June 2016. Through this instruction Widodo calls on all relevant ministries - including the Health Ministry, Industry Ministry and Finance Ministry - to take efforts to boost development of Indonesia's pharmaceutical industry. The Health Industry has a key task to write an action plan for the development of a self-sufficient pharmaceutical industry and to boost competitiveness.

Indonesia's pharmaceutical industry is highly dependent - for some 90 percent - on imports of raw materials from abroad. Considering that sales in the nation's pharmaceutical industry are expanding by around 10 percent year-on-year (y/y), it implies imports of raw materials will continue to rise, especially now the Indonesian government is eager to turn its ambitious universal healthcare scheme (in Indonesian: Jaminan Kesehatan Nasional, or JKN) into a success. JKN, which was implemented by the social security agency Badan Penyelenggara Jaminan Sosial Kesehatan (BPJS) in early 2014, aims to provide all Indonesian citizens with access to a wide range of health services (by 2019). If conditions do not change but the JKN program is a success, then it would imply a significant surge in imports of raw materials, putting pressure on Indonesia's trade and current account balances.

The presidential instruction also orders the Health Ministry to create an integrated data system that covers the demand, production and distribution of pharmaceutical supplies and healthcare services. Meanwhile, the process to obtain permits to develop a pharmaceutical factory should be simplified. Furthermore, BPJS needs to improve its capacity to pay bills submitted by local hospitals and health clinics.

Earlier this year we reported about the growing mismatch between claims paid and premiums received by BPJS. The subsequent growing deficit undermines the financial sustainability of the whole program. Moreover, given that 90 percent of medicines' raw materials are imported, part of BPJS' funds (taken from the central government's state budget) flow abroad.

Presidential Instruction No. 6/2016 also calls on Indonesia's Finance Ministry to provide fiscal incentives in order to attract investment in the pharmaceutical industry. Also the Indonesia Investment Coordinating Board (BKPM), the government agency that provides investment services, is tasked to create new policies that boost investment in this sector.

Earlier this year the Indonesian government had already widened room for foreign ownership in factories that produce raw materials for medicines from 85 percent to full 100 percent foreign ownership. However, more incentives are needed to attract investment.

http://www.indonesia-investments.com/

In June 1981, the Centers for Disease Control announced that a strange infection was showing up in Los Angeles.

Five patients had severely weakened immune systems, and many were suffering from an extremely rare form of pneumonia. Doctors couldn't figure out how a cluster of previously healthy, young gay men had gotten so sick so quickly.

The warning from Los Angeles was soon followed by reports of similar cases in New York, San Francisco, and other cities.

By the end of that year, at least 121 people had died from the then-mysterious disease. By the end of the decade, the syndrome, which we now know as AIDS, had become a pandemic, taking more than 59,000 American lives. Worldwide, the World Health Organization (WHO) estimated, there were up to 400,000 cases.

Since the beginning of the epidemic, AIDS has claimed about 34 million lives. And there are an estimated 36.7 million people worldwide currently living with HIV, the virus that causes AIDS. It's still the leading cause of death for women of reproductive age (15-44) worldwide.

But the tide is finally turning, and stopping a disease that once seemed unbeatable is now very much within our reach.

A plan to end AIDS
On June 8, almost exactly 35 years since the start of the AIDS crisis, the United Nations announced a new set of goals that would put the world on track to end the epidemic by 2030. That's not only amazing, but entirely possible.

AIDS, or acquired immunodeficiency syndrome, is a disease caused by human immunodeficiency virus, or HIV. The virus attacks the immune system, specifically infection-fighting CD4 or T cells, until the body no longer can defend itself from opportunistic infections. Doctors diagnose a patient with AIDS, the final stage of HIV, when they develop opportunistic infections or the concentration of CD4 cells falls below a certain point. HIV is transmitted through blood and other bodily fluids — most people contract it through unprotected sex or intravenous drug use with contaminated needles. Mothers can also transmit the virus to their children during pregnancy or breastfeeding.

The targets set out in what's called the UNAIDS Fast-Track plan are ambitious, but important. The first goal is the 90-90-90 target: By 2020, 90% of people with HIV will know they're infected, 90% of those who know will have access to treatment, and 90% of people in treatment will be successfully suppressing the levels of the virus in their system. Also by 2020, the UN hopes to see 500,000 or fewer new infections among adults.

By 2030, the UN has set a goal to limit new infections among adults to 200,000, with treatment goals boosted to 95-95-95.

We've already come so far

That may sounds like a tall order, but the strides made in the fight against AIDS in rich countries is tremendous. In the United States, deaths from AIDS-related illnesses peaked in the early 1990s and have fallen steadily ever since.

Globally, the most devastating year was 2005, when AIDS killed 2 million people, but that number's been falling too — down to 1.1 million in 2015. New infections have declined by 6%, and among children, new cases are down 50%. On Monday, Australia announced that AIDS was "no longer a public health issue" in the country, according to Reuters.

With access to treatment, HIV is far from the death sentence it was at the height of the American epidemic — by blocking the growth of HIV cells with antiretroviral drugs, patients can live with HIV longer than ever and even avoid AIDS altogether. The risk of a pregnant mother transmitting HIV to her child can now be reduced to less than 5% with proper medical intervention.

As treatment has improved, so has prevention. A study released in the Journal of the American Medical Association (JAMA) on Tuesday tracking long-term, committed couples with different HIV statuses showed that antiretroviral therapy can also prevent an HIV-positive person from transmitting the virus to their uninfected partner.

In 2012, the Food and Drug Administration approved a combination of drugs called Pre-Exposure Porphylaxis, or PrEP, which can reduce the risk of infection by up to 92% for daily users.

'The issue is access'
Right now, the UN estimates that only 57% of people living with HIV know their status, and fewer than half have access to antiretroviral treatment. The rates of new infection are on the rise again — even in Australia, where HIV diagnoses actually rose by 13% over the past decade, despite the plummet in cases of full-blown AIDS.

And while treatment and prevention options have improved drastically, there are stark disparities in who has access to those options around the world.

"Today, we have multiple prevention options," said Michel Sidibé, executive director the UN's AIDS program, in a press release. "The issue is access — if people do not feel safe or have the means to access combination HIV prevention services we will not end this epidemic."

Which is why one another important number in the plan the global AIDS epidemic is zero: Zero discrimination against people living with or vulnerable to HIV infection.

http://www.techinsider.io/

PARIS • The world should brace itself for a potentially devastating impact on human health due to climate change, top policymakers and officials from around the globe meeting in Paris have said.

Some consequences may be avoided if humanity radically curbs its use of fossil fuels in the coming decades, but many are already being felt, they said at the opening on Thursday of a two-day conference run by the World Health Organisation (WHO) and hosted by France.

"Health and climate are inextricably linked because human health depends directly on the health of the planet," French Environment and Energy Minister Segolene Royal told participants.

Ms Royal, also the rotating president of United Nations-led talks on how best to cope with global warming, said health impact must play a more central role in future negotiations. "From now on, I will do my best to ensure that health is integrated into all future climate conferences," starting with a special forum at the 196-nation UN climate meeting in Marrakesh in November, she said.

The Paris Agreement, inked last December, calls for holding global warming to well under 2 deg C and helping poor nations cope with its impact. A crescendo of scientific studies paints an alarming picture of the human suffering in store due to disrupted weather patterns, rising seas, droughts and superstorms.

Tropical disease vectors - for malaria, dengue and Zika, to name a few - are expanding as the insects that carry them spread following warming climes.

Extreme heatwaves set to occur every decade rather than once a century will claim more lives, especially the ill and the elderly. WHO estimated in 2005 that killer hot spells claim 150,000 lives annually.

Most worrying of all, perhaps, is the threat to global food supplies. Many staple foods, especially in the developing world, cannot adapt fast enough to changing weather, resulting in lower yields. Fish - a key source of protein for billions - have not only been depleted by industrial harvesting, but also are migrating as oceans warm and coral reefs die.

Sometimes it is the sources, rather than the impact, of manmade climate change that damage health.

WHO estimates seven million people die each year from air pollution, which also contributes to global warming. "The health sector has been under-represented in this discussion when you think about the millions of lives that will be affected, and even ended," said the UN climate forum's interim head Richard Kinley.

The Second Global Conference On Health and Climate was due to end yesterday with a proposed "action agenda" for national governments.

http://www.straitstimes.com/

Participants attending the Second Global Conference on Health and Climate, hosted by the Government of France, COP21 presidency, proposed key actions for the implementation of the Paris agreement to reduce health risks linked to climate change.

The World Health Organisation (WHO) estimates that climate change is already causing tens of thousands of deaths every year. These deaths arise from more frequent epidemics of diseases like cholera, the vastly expanded geographical distribution of diseases like dengue, and from extreme weather events, like heat waves and floods.

At the same time, nearly 7 million people each year die from diseases caused by air pollution, such as lung cancer and stroke.

Experts predict that, by 2030, climate change will cause an additional 2,50,000 deaths each year from malaria, diarrhoeal disease, heat stress and undernutrition alone.

The heaviest burden will fall on children, women, older people and the poor, further widening existing health inequalities between and within populations.

The conference highlighted the benefits of switching to cleaner energy sources. These will help reduce levels of climate and air pollutants, as well as providing desperately needed power for health facilities in low-income countries. The health sector should themselves make a greater effort to promote low-carbon healthcare facilities and technologies; these can simultaneously improve service delivery and reduce costs as well as climate and environmental impacts.

The participants called for countries to adopt a new approach to link health economics assessment and climate change, for example, by calculating the avoided healthcare costs, when countries invest in mitigation of climate emissions, and protection from climate risks.

To develop this work, WHO announced a new working group which will articulate a new coherent approach to health economics and climate change. To do so, it is recommended that countries spend more on protecting health from risks linked to climate, such as extreme weather events and outbreaks of infectious disease and in cleaner energy sources, more sustainable transport systems and urban planning that also reduces major health risks, for example air pollution in cities and in the home. Recommendations also focus on scaling up financing on climate change and health through additional resources and mechanisms and existing resources earmarked for adaptation.

http://www.thedailystar.net/

Bali, Indonesia, 30 June 2016 – The World Health Organization (WHO), governments, financial institutions, development partners, and health agencies from across the world have committed to accelerate strengthening and implementation of capacities required to cope with disease outbreaks and other health emergencies.

A significant threat to global health security is the number of national health systems that are weak, fragmented and under-funded. Only about one third of countries in the world have the ability to assess, detect and respond to public health emergencies. Ebola, Zika, yellow fever and other recent outbreaks have exposed these weaknesses at national, regional and international levels.

"Fortifying health security in today's world must be a key priority of governments, multilateral agencies, development banks, and non-government organizations the world over. What matters most is maintaining the momentum and turning that into real, tangible results," Dr Poonam Khetrapal Singh, Regional Director, WHO South-East Asia Region said at the end of the three-day meeting on 'Advancing Global Health Security: From Commitments to Actions', which ended here yesterday. The meeting brought together 250 participants from 52 countries representing 28 different organizations.

Speaking at the opening of the event, Dr Matshidiso Moeti, WHO Regional Director for Africa, said "the bedrock of outbreak and emergency preparedness and response is a functioning, resilient national health system – with the financing, human resources, infrastructure, information and supply management systems capable of detecting and responding to public health events."

Renewed commitment to health system strengthening in-line with the International Health Regulations (2005) is needed, especially in vulnerable countries. The true power of health systems is their ability to deliver timely, quality health services to those in need in a comprehensive way and on an adequate scale. These systems are especially important during emergencies, when access to quality essential health services can be severely compromised.

The meeting highlighted the critical importance of flexible preparedness planning, community strengthening and engagement, information sharing, strengthening of intersectoral collaboration of national and international partnerships, and the critical role that governments and technical partners play in financing and implementing them. Investing in these systems requires strong ownership and supportive leadership at the highest levels.

A number of side events also took place during the meeting, notably a World Bank Group meeting on sustainable financing for preparedness; an Alliance meeting on the acceleration of IHR implementation; and a Government of Indonesia meeting on zoonoses.

From commitment to action

The meeting in Bali is the second high-level WHO meeting to advance global health security. The first meeting took place in Cape Town, South Africa in July 2015. Since then, considerable preparedness strengthening activities have taken place and been implemented, especially in vulnerable countries.

A significant advancement since the Cape Town meeting is the WHO joint external evaluation (JEE) process, which is one of four components of the new WHO IHR Monitoring and Evaluation Framework. The WHO JEE process helps to identify strengths and weaknesses in national health systems and in other sectors which play a key role in health emergency preparedness and response.

The results of the WHO JEE is shared publicly and will support the country and its partners in developing a national action plan linked to the national budget and planning cycles, anchored in the health system and supporting its implementation in the country.

The JEE process reflects the underlying principles of the strategic framework for emergency preparedness that was fine-tuned at the Bali meeting, including transparency, accountability, multisectorality, partnership, sustainability, and alignment. Key to the Bali framework is the building of robust health systems in order to achieve universal health coverage (UHC) by methods that are efficient, country-focused, transparent and accountable, and strengthening and maintaining the effectiveness of global health security as a global public good.

WHO has also created an open-access web platform called the Strategic Partnership Portal (SPP) to help identify country needs, gaps and partner activities to ensure resources are used more efficiently, without duplication. Training on how to use the SPP, mandated by WHO Member States and supported by health partners, has been rolled out in several high-risk countries in Africa, with planned expansion to other WHO Regions in 2016.

http://www.searo.who.int/

The World Health Organization (WHO) has named a chief to head up its new health emergencies unit. The UN agency was criticized for its response to the Ebola outbreak in West Africa, prompting it to set up the new unit.

Peter Salama, an Australian epidemiologist who is currently UNICEF regional director for the Middle East and North Africa, has been tapped to head the WHO's health emergencies unit and will take up his post in July.

The program he will run was set up after the WHO was accused of "egregious failure" in handling the Ebola crisis, during which over 11,000 people died as the disease spread through Guinea, Sierra Leone and Liberia in 2015 and early 2016.

The unit will provide rapid support for any country or community facing a health emergency arising from disease, natural or man-made disasters or conflict, the WHO said in a statement.

The Ebola epidemic caused "immense human suffering, fear and chaos," which went "largely unchecked" by the WHO's leadership, a specialist health panel said last year.

Children in the front line

Meanwhile, the UN children's agency said this week that 69 million children under five will die from preventable causes between now and 2030 if action to improve health and education for the most disadvantaged is not accelerated.

UNICEF has said in its annual report that 167 million children will also live in extreme poverty, 60 million won't be attending primary school and 750 million women will have been married as children by 2030 unless inequality is tackled now.

Many are fleeing because of poverty and inequality, UNICEF's Deputy Executive Director Justin Forsyth said. "These root causes must be addressed if you're going to stop some of these forces overwhelming particular countries and polarizing the political debate," he said. "Our job in UNICEF is to be there on the ground and helping children survive," he added.

UNICEF has called on all 193 UN member states to develop national plans that put the most disadvantaged children first and set clear goals to close gaps between the richest and poorest.

http://www.dw.com/