The Ebola virus outbreak in West Africa has not just illustrated the absence of political commitment towards public health, but it has also initiated discussions on the security of global health. A group comprising of leading practitioners of health have now presented their thoughts on the impact of this epidemic in several essays published in The Lancet. In this essay, Different perspectives have been critically looked at on what the Ebola outbreak has got to teach us. In areas like health care access for individuals, the epidemic can increase political commitment for improving healthy security and how other related issues like antimicrobial resistance are relevant to the security of health have been investigated.

Professor of Infectious Disease Epidemiology at London School of Tropical Medicine and Hygiene, London, UK and lead author of the review, David L.Heymann has described health security as being essentially the protection from various threats to health.

The professor said that throughout history, the approach to threats like the Ebola epidemic has been focused on rapid response and rapid detection of these outbreaks. According to him, this approach has overtime become the commonly understood concept of healthy security for several centuries. But, the Ebola crisis has highlighted a second and equally crucial aspect of global health security that is not considered and that is making accessibility to health products and services more accessible at a personal level around the globe. He also said that this should be better recognized as an integral part in the scope of global health security.

One of the essays also made a suggestion that global healthy security has remained politically neglected for over a decade through the lesser importance given by the WHO and the legal noncompliance by certain countries.

source: http://www.dispatchtimes.com/

A year after its launch on Jan. 1, 2014, the Social Security Organizing Body (BPJS), which provides health care and insurance schemes for Indonesians, has posted a Rp 1.93 trillion ($148.22 million) deficit as claims exceeded premium income.

The health insurance agency generated Rp 40.72 trillion in premium revenue last year from its customers, which include employers, employees, workers of the informal sector and government officials.

Meanwhile, claims from customers — which include spending on curative health care, and rehabilitative in-patient care, preventive services like shots and screening tests — stood at Rp 42.65 trillion.

Of this figure, Rp 8.34 trillion was paid to 18,437 community health clinics, known as Puskesmas and Rp 34.31 trillion was paid to 1,681 hospitals.

The mismatch between claims and premium revenue means the government has to step in.

"We expect the deficit can be plugged with a government [cash] injection," said Fahmi Idris, chief executive for the BPJS's unversal health care branch known as BPJS Kesehatan.

This year, the agency expects to receive up to Rp 5 trillion in funds from the government, of which Rp 3.46 trillion is expected to be disbursed sometime in the first half of this year, while the remainder will be allocated at the end of 2015.

Through the BPJS, the government subsidizes health premiums for all Indonesians, including citizens working in the informal sector.

The government is still working to get as many health institutions as possible to participate in the program.

The agency had already estimated a potential deficit of up to Rp 1 trillion for the first quarter of 2015, said Riduan, its finance and investment director. Claims from January to March are expected to reach Rp 13 trillion, while the agency receives an average of Rp 4 trillion from premium income per month, he added.

This means premium revenue for the first three months stood at Rp 12 trillion, yielding to a shortfall of Rp 1 trillion.

In addition to seeking financial support from the government, the agency is working to make improvements in its operation that would allow it to generate more revenue and optimize claims.

Its efforts include revising the activation date of insurance cards and raising the amount of premiums.

Starting June this year, new participants will only be able to use the health insurance card two weeks after they register — only slightly longer than the current seven days.

This is done to avoid "free riders" — people who only register when they are sick, or know they would need to pay for health care services in the immediate future.

With regard to the premium, Riduan said the health agency is still reviewing the current figure, although he signaled the possibility of an increase.

The current premium for clients of BPJS Kesehatan's health insurance schemes ranges from Rp 25,500 to Rp 59,500 per month, per person.

"The increase plan will start in 2016, not this year," Riduan said.

He added that the agency still has Rp 400 billion in unpaid premium bills from regional governments who registered their officials last year.

These local administrations first need approval from their legislators to settle budget spending, delaying their premium payments.

Also, more than 2 million registrants from the workers category have yet to pay their premiums.

Riduan said BPJS Kesehatan also plans to cooperate with state lenders to help participants in making their payments, including Bank Rakyat Indonesia, Bank Mandiri and Bank Negara Indonesia.

source: http://thejakartaglobe.beritasatu.com/

It has now been over a year since the Ebola outbreak in West Africa was first reported and it has since gone on to become the deadliest occurrence of the disease since its discovery in 1976, claiming the lives of more than 10,000 people. So what has the outbreak taught us and how prepared are we for the next global health crisis?

What lessons have been learned from Ebola?

We have learned that the initial response to an outbreak must be robust and complete so that the outbreak does not spread from rural areas, where it emerges from an animal source in nature, into neighbouring countries and urban areas.

We have also learned that community engagement is of the utmost importance - helping village elders, paramount chiefs and others understand how the disease is transmitted and how it can be stopped, including emphasis on safe burial practices.

Equally important is contact tracing - and daily monitoring of the temperature of those who are known to have been in contact with a patient - for three weeks, in order to identify those who are potentially infected with Ebola; and surveillance to identify patients and ensure their transport and management in a health facility where infection control is up to standard.

Ebola transmission is amplified if patients are admitted to health facilities where infection control is sub-standard; and where health workers inadvertently become infected and then unintentionally infect their family members, spreading the infection to the community.

Health workers are often infected because it is impossible to diagnose Ebola early - it has signs and symptoms similar to other infections such as malaria - and they are therefore at great risk of infection. It has been shown that the Ebola virus does not cause major outbreaks where health facility infection control is up to standard.

The best means of dealing with an international health crisis is prevention - it has been known, for example, since 1976 that it is sub-standard health facility infection control that permits Ebola to spread, yet sub-standard infection control continues in many facilities. Emphasis must be placed on helping health facilities understand and use infection control measures as part of their routine activities.

The International Health Regulations are international laws that are meant to help prevent the international spread of disease, and they required countries to develop standard core capacity in public health between the years 2007 and 2014, yet many countries did not accomplish this and continue to be at great risk of not detecting and responding to outbreaks early, when their spread can be prevented.

What dangers lie ahead?

There continue to be many infectious disease risks that can spread internationally - some of them are known, others unknown. Those that are known include infections resistant to the medicines used to cure them (antimicrobial resistant infections). Infections such as Dengue, Chikungunya, and cholera all continue to spread throughout the world.

Those that are unknown - they emerge from a source in nature to infect humans - sometimes also have the potential to spread internationally. Sars in 2003 is an example - and others, such as Ebola, re-emerge from time to time. It is impossible to predict when these latter, emerging infections, will emerge or re-emerge, so it is important that all countries develop the public health capacity to detect and respond to infectious diseases when and where they emerge or re-emerge.

The way forward must therefore include stronger government engagement in developing core capacities in public health so that outbreaks can be rapidly identified and contained when and where they occur; and strengthening of global alert and response mechanisms to ensure a rapid and robust response - a safety net when countries are unable to detect and contain outbreaks on their own.

David Heymann is head and senior fellow, Chatham House Centre on Global Health Security, and professor of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine.

source: http://www.bbc.com/

More than 2 million participants have fallen behind on National Health Insurance (JKN) premium payments, contributing to the programme's financial difficulties last year.

The Healthcare and Social Security Agency (BPJS Kesehatan), the insurance operator, reported that 2,158,584 people had been late in their premium payments for three to six months.

"Those who are late in their payments are mostly workers who do not receive fixed salaries," BPJS spokesperson Irfan Humaidi told The Jakarta Post recently. "They are people who register when they fall ill, but stop paying once they recover."

There are 1,915,424 participants in this category, while 242,653 long-time members have failed to keep up with premium payments, including those covered by the Jamsostek insurance programme. A further 175 members have become late-payers after retiring from their jobs.

Irfan said that the rate of non-compliant participants had not harmed the agency's finances, since their number accounted for less than two per cent of the current 140 million JKN participants.

Each JKN participant is required to pay premiums of differing sums, starting from Rp 25,500 (US$1.96) per month.

BPJS Kesehatan expects to remain in the red throughout this year, with its claim ratio expected to hover around 100 per cent. The claim ratio is the difference between the hospitals' bills for health services provided and the premiums collected by the agency from participants registered in the programme.

Separately, the National Social Security Board (DJSN), which is tasked with monitoring the programme, said that while the number of late-payers might be relatively small now, BPJS Kesehatan should not ignore these groups of people.

"If non-compliant participants are ignored and there's no punishment, their numbers will swell," DJSN head Chazali Husni Situmorang told the Post.

BPJS Kesehatan should hunt these late-payers, he argued, a simple process since the agency already had their addresses and phone numbers.

"The agency has to have a strategy. For example, the marketing division should call all those who are late in their payments. The agency could also utilize a system to send automated SMS," said Chazali.

Irfan said that the agency had already sent bills via text message.

"Moreover, late-payers receiving treatment at hospitals will receive notification that they haven't paid," he said.

After six months without payment, they are no longer eligible for health treatments, according to Irfan.

The late-payers also have to pay a fine of two per cent of the total premiums before they can resume their membership in the JKN programme.

"The fine is too small. It should be increased incrementally," Chazali said. "If the fine is too small, then its deterrent effect is negligible."

He also suggested that the BPJS Kesehatan require its participants pay premiums once every six months, instead of monthly.

"It would counter late payments. And it doesn't violate the law because the law doesn't stipulate that BPJS Kesehatan must collect premiums every month," said Chazali.

He also suggested that BPJS Kesehatan publish the names of late-payers in local media or government offices to shame them.

Lastly, Chazali said, BPJS Kesehatan could team up with state-owned electricity company PLN and state-owned telecommunications company Telkom to target late-payers.

"When they pay their electricity bills or phone bills, they could be reminded to pay their JKN premiums," he said

source: http://business.asiaone.com

Republican congressional leaders are eager to give President Obama Trade Promotion Authority, or "Fast Track." Proponents argue that Fast Track will break the logjam holding up important international trade agreements like the Trans Pacific Partnership (TPP), which includes countries as diverse as Australia, Canada, Peru and Vietnam.

Fast Track would allow the president to finalize the agreement before sending it to Congress for a straightforward up-or-down vote within a limited time. However, the likelihood of Fast Track resulting in TPP getting a "thumbs up" from Congress is limited by potential differences between the president and the congressional majority on intellectual property rights.

In a recent Wall Street Journal op-ed, Representative Paul Ryan (R-WI) and Senator Ted Cruz (R-TX) asserted that the administration must pursue a number of negotiating objectives, including "beefing up protections for U.S. intellectual property" if it wants Congress to approve the TPP.

It is uncertain the president is as committed to intellectual property as Mr. Ryan and Mr. Cruz hope, especially with respect to patents for medicines. Although the text of the TPP is not yet available to the public, the U.S. Trade Representative, who negotiates in the president's name, insists that "TPP countries have agreed to reflect in the text a shared commitment to the Doha Declaration on TRIPS and Public Health."

The 2001 Doha Declaration was an attempt to limit international trade agreements' commitment to patent rights that were accepted in the World Trade Organization's 1995 Trade Related Aspects of Intellectual Property Rights (TRIPS) Agreement. It insists that low and middle-income countries should have broad latitude to allow generic drug makers to make copies of patented medicines through a legal mechanism called "compulsory licensing."

The Doha Declaration was an important achievement for well-intentioned advocates for public health, such as Doctors Without Borders (known also by its French acronym MSF), which has just launched an advertising campaign designed to gut patent rights in the TPP. MSF claims – reasonably – that poor countries and nonprofits cannot afford to pay the prices that manufacturers can negotiate with payers in wealthier countries.

Unfortunately, attacking patents is a misguided way to improve access to medicines in low and middle-income. Although it is a counter-intuitive conclusion, strong patent rights are a better way to achieve this goal.

In an international environment of strong patent rights, innovative drug makers would have every incentive to lower prices voluntarily to poor countries. Costs of manufacturing and distribution are a small percentage of prices charged for patented medicines in the United States. The reason the government recognizes patents is so the manufacturer can charge enough to earn a return on investment in research and development.

source: http://www.forbes.com/

In 2012, the FDA warned physicians and medical practices that their supplies of bevacizumab, an expensive drug used in combination with chemotherapy to inhibit tumor growth, might be tainted. It turns out some hospitals were literally giving cancer patients cornstarch instead of anticancer meds: The FDA found that some batches of the counterfeit beyacizumab contained no active pharmaceutical ingredients at all.

Tim Mackey, director of the Global Health Policy Institute, said that even today it's hard to guess exactly how many patients were exposed to the counterfeit bevacizumab; those being treated would have a high mortality rate anyway. "It's kind of like the perfect crime," Mackey said.

Further obscuring the extent of the ersatz drug is the maze of grey market distributors it wound through. Before the counterfeit bevacizumab arrived in the United States, investigators found, it traveled through Turkey, Switzerland, Denmark, the U.K., and Canada.

Despite the scope of this scandal, the security of our medical supply chain hasn't improved much. "It could happen tomorrow and we wouldn't be any more protected," Mackey said.

The process for reporting incidents of counterfeited drugs around the world is severely impaired, a study published today in the American Journal of Tropical Medicine and Hygiene has found. Of 169 countries, 127 reported no counterfeit incidents at all, meaning, Mackey said, that many countries are simply ignoring the problem. Without an accurate picture of the security of the medical supply chain, it's difficult for governments to crack down on drug counterfeiting. The study is the first global-scale assessment of drug counterfeiting.

The study found that counterfeit medicine turned up in a range of settings: from small community pharmacies providing anti-malarial drugs to U.S. clinics providing anticancer treatment. From 2009 to 2011, the study counted 1,799 different types of counterfeited medicine across 1,510 reports of "counterfeit incidents," which encompass a range of situations or quantities of drugs, worldwide. A customs official unearthing multiple counterfeited drugs, for example, would be counted as one incident.

China reported the largest number of counterfeit incidents, followed by Peru, Uzbekistan, Russia, and Ukraine. However, Mackey said, these finding should be taken with a grain of salt: Countries such as China, which has a reputation for counterfeit medicine, might be looking for counterfeit drugs and therefore turn up more, while other countries, such as India, might be ignoring drug security in part to delay having to address it. "The countries and numbers would look really different," with more accurate reporting, Mackey said.

Although the study's data might be limited, it emphasizes the need for a standardized procedure and system for reporting counterfeit medicine worldwide. The majority of counterfeit drugs—about 53 percent—fall under "lifesaving-related drug categories," the study found.

"There's this global drug supply chain, and there's gaps in it," Mackey said. "We really need to make this a global priority."

source: http://www.newrepublic.com/

Numbers surround us every day, from the code used to communicate between mobile phones to the number of plates needed for lunch. It is easy to forget exactly how important these numbers really can be, especially when removed from the actual people or functions they represent. This year, I have been working as a Monitoring and Evaluation Officer for the Uganda Village Project, a NGO based out of the rural district of Iganga, Uganda. Throughout my year, I have seen numbers: HIV testing numbers, malaria bed net distribution numbers, family planning outreach numbers, obstetric fistula repair surgery numbers, among thousands more. In the daily deluge of information, I must constantly remind myself that these numbers, though aggregated for analysis, represent actual people and lifesaving situations. The 15 participants who received the Depo shot at the last outreach in Namunkesu represent 15 women who are planning their families for a brighter future for themselves and their own. The 150 participants who received HIV test results mean that there are 150 villagers in Bukaigo that can receive ART treatment if necessary, and sleep easier that night knowing their status. The people of these villages are the true representation of the numbers, but unfortunately the human story is too often divorced from them after collection in order to do mega-analyses and aggregation.

This past month I had the incredible opportunity to help lead an impact evaluation research project of the villages where UVP does their work. Currently they have worked in 24 villages out of a list of 70. Julius (my co-fellow) and I were tasked to collect data from 15 households in each village to see if the intervention villages differ from the non-intervention villages. It was a busy six weeks; we both were responsible for supervising a team of enumerators and worked Monday through Saturday 10 hours a day. All of the data collection happened in dry season, meaning better roads but also constant 95-degree temperatures (35 degrees Celsius). Despite the challenges, the collection went well and gave both Julius and I a chance to interact with the "numbers" we had been working with all year. Reading on a computer screen that a family has four children and the mother is using family planning is no substitute to seeing the pride and joy shining from her face when talking about her family's health and wellbeing. During our 36 days of data collection, I was able to see the numbers come alive, and it left me with a profound gratitude for the life-changing work my organization is doing. Not all numbers tell a happy story, sadly, and directly viewing the challenges also has left a deep impact on me, and an insatiable desire to do more.

The Iganga District is very rural and one of the poorest for the amount of access to health the populous should have; the main artery road from Nairobi to Kampala almost bisects the district. This has traditionally resulted in greater government investment, but also in a host of problems brought in by transportation workers and other migrants. With a large government hospital already in place in Iganga, and a private one being built, there is no reason that any women should give birth without an attendant, or for any life-threatening health situation to go untreated. We found lack of access to be the case time after time and were able to see firsthand the pain of sick family members or lost loved ones. This is unacceptable to me, and shows just how far we still have to go for health equity in rural locations around the world. Health should not be something that can only be accessed by those who have the means to pay for treatment, but should rather be shared by everyone, especially those in fragile economic situations.

How de we solve these issues? I am not sure if I have the answer for that, but I am confident that programs such as Global Health Corps, Uganda Village Project and their host of other partner organizations are working towards a viable solution. The Iganga District is changing: Overall health is increasing and people are generally more knowledgeable about healthy behaviors than they were 10 or 15 years ago. This change has come slowly though, and many thousands of lives have been negatively affected in the meanwhile. I may not have the solution, but I do have my experiences and skills that I continue to use to promote health equity and justice. The journey for a healthy world is far from over, and I am ecstatic that I am able to do my part to support that important voyage.

Numbers still surround me on a daily basis, but I can take satisfaction in knowing that they are no longer only numbers. I have seen the source of these numbers, and their stories and faces will continue to be present in my daily data use for as long as I work in this field.

source: http://www.huffingtonpost.com/

The World Health Organization (WHO) has admitted serious failings in its handling of the Ebola crisis, its leadership said in a statement seen by Reuters on Sunday.

"We have learned lessons of humility. We have seen that old diseases in new contexts consistently spring new surprises," said the statement, attributed to the WHO Director-General Margaret Chan and the deputy director-general and regional directors.

"We have taken serious note of the criticisms of the Organization that, inter alia, the initial WHO response was slow and insufficient, we were not aggressive in alerting the world ... we did not work effectively in coordination with other partners, there were shortcomings in risk communications and there was confusion of roles and responsibilities...," it said.

source: http://www.israelnationalnews.com/