LAHORE: The World Health Organization (WHO) has launched a global scheme -- Good Governance for Medicine (GGM) Programme -- in Pakistan with an objective to prevent corruption by promoting good governance in the pharmaceutical sector and to ensure provision of essential medicines to the masses.

Since the medicines represent one of the largest components of health expenditure, the GGM Programme is the first initiative of its kind which has been kicked off in Pakistan to bring revolutionary reforms in the system that revolves around the registration, manufacturing, distribution, supply, and selling of drugs. It will help avert the Punjab Institute of Cardiology, Lahore's, like drug reaction scam.

WHO Pakistan's Country Adviser on Essential Medicines Syed Khalid Saeed Bukhari said the WHO had selected 15 countries from 22 member states of the Eastern Mediterranean region, including Pakistan, to run the global programme as a pilot project. The other countries are: Lebanon, Jordan, Afghanistan, Bahrain, Egypt, Iran, Iraq, Kuwait, Morocco, Palestine, Sudan, Tunis, Syria and Yemen.

He said the GGM Programme currently operates in 26 countries across the six WHO regions and these states are at different stages of implementation. Other major reasons associated with the scheme are to curb corruption in pharmaceutical sector by increasing transparency and accountability and promoting ethical practices.

The federal and all provincial governments have nominated two each advisers/assessors for this prgramme while four are nominated by the private sector. A total of 30 advisers will be engaged by the WHO to materialize the scheme, he said.

Mr Bukhari said the WHO had initiated the programme in 2004 keeping in view the health sector a very real target for corruption and other unethical practices.

He said the WHO had been giving much weightage to this programme because despite many efforts to make essential medicines accessible to all, it was estimated that one-third of the global population did not have regular access to them.

The GGM Programme was launched in three steps/phases that included national transparency assessment, development of a national GGM framework and implementation, he said.

The scheme would be materialized within about three months in phases. In the wake of its starting phase, the first session of experts of both the WHO and Pakistani nominated advisers will be held on Monday (today) in Lahore, Khalid Bukhari said.

PHASE I:

The first phase is to measure transparency in the public pharmaceutical sector by providing a comprehensive analysis of the level of transparency and its vulnerability to corruption.

The national assessment will be carried out using the WHO standardized assessment instrument which focuses on central functions of the pharmaceutical regulation and supply systems.

The objective of the national assessment is to provide the country with a comprehensive picture of the level of transparency and potential vulnerability to corruption of eight functions of the pharmaceutical sector: registration of medicines, control of medicine promotion, inspection of establishments, control of clinical trials, licensing of establishments, selection of essential medicines, procurement of medicines and distribution of medicines.

The assessment is an essential step in developing national programme for promoting good governance in the public pharmaceutical sector and revising related administrative procedures through a national consultation process.

The transparency assessment is not an end in itself, but rather the beginning of a process aimed at bringing long-lasting changes through efforts to promote good governance practices among health professionals in the public pharmaceutical sector.

The implementation of assessment's recommendations will build a more transparent and accountable pharmaceutical sector, improving equitable access to good-quality and safe medicines.

PHASE II:

Following the national assessment, the basic components of the GGM Programme will be defined through a nationwide consultation process with key stakeholders and will be based on experience accumulated in various countries.

These components will include an ethical framework and code of conduct, regulations and administrative procedures, collaboration mechanisms with other good governance and anti-corruption initiatives, whistle-blowing mechanisms, sanctions for reprehensible acts and a GGM implementing task force.

The results of the assessment in Phase I -- identifying the loopholes in the systems -- will help in applying the discipline-based approach. In the light of the findings, laws and administrative structures and procedures will be adjusted in terms of medicines regulation and supply.

PHASE III:

The last step will be to implement a national programme of good governance for medicines and institutionalization.

The implementation of the programme requires the systematic training of government officials and health professionals.

source: www.dawn.com

During an official visit of the UNAIDS Deputy Executive Director, Jan Beagle to Indonesia, national and provincial municipal leaders, development agencies and civil society organizations underlined the importance of scaling up and investing in city-based HIV strategies as a critical action towards accelerating progress in the AIDS response.

Speaking with the National AIDS Commission Director Dr Kamal Siregar, Ms Beagle stressed the importance of focusing on city-based HIV responses at a time when the majority of people living with HIV and from key populations at risk reside and/or work in municipal centres. Dr Siregar noted how scaling up programmes and efforts at the city level will enable greater reach to people in need of HIV services, especially among key populations at higher risk.

Jakarta, the capital city of Indonesia is one of the provinces with highest numbers of new HIV infections in Indonesia. The estimated number of people living with HIV in the city as of 2013 is approaching 100 000. According to national surveillance data, estimated HIV prevalence among key populations at higher risk in the city is higher than national averages with 56.4% prevalence found among people who use drugs, 17.2% among men who have sex with men and 10.5% among female sex workers.

Indonesia's Deputy Minister of Health echoed the need to make cities central to HIV responses noting that city populations often contain large numbers of young people and that youth focus and engagement for HIV is also critical.

Enhanced city-based focus was also welcomed by the Secretary General of the Association of Southeast Asian Nations (ASEAN), which is spearheading the ASEAN 'Cities getting to Zero' initiative. Meeting with Ms Beagle, ASEAN Secretary General Le Luong Minh stressed how the 'Cities getting to Zero initiative' is focusing on 13 ASEAN cities and municipal areas—which account for large proportions of HIV burden in their countries (including three in Indonesia)—to catalyze country actions towards the achievement of the 2012 ASEAN Declaration on Getting to Zero New HIV Infections, Zero Discrimination, Zero AIDS-related Deaths.

UNAIDS is working to increase the focus on city-based HIV responses. Cities and their importance within the HIV response will also be discussed at the International AIDS Conference to be held in Melbourne, Australia from 20-25 July.

Quotes

"We need to expand comprehensive HIV prevention and treatment in cities to reach the maximum amount of people. We also need to replicate quality and proven city programmes – to from one city to another to help faster and better scale up."

Kamal Siregar, Director of the National AIDS Commission of Indonesia

"In our ASEAN 'Cities getting to Zero' initiative, the enrolled cities have been very active and enthusiastic. Learning about similarities and differences between the cities on HIV issues is very important. We are documenting the experiences and this will be released later this year."

ASEAN Secretary General Le Luong Minh

"From a programme coverage perspective and from an effective investment perspective, increased focus on cities and metropolitan areas can make an important impact. Cities in Indonesia have significant experiences to share that highlight both successes and challenges."

UNAIDS Deputy Executive Director, Jan Beagle

source: www.unaids.org

The Canadian official who heads the WHO's polio eradication effort says of the many challenges facing the quarter-century-old program, evidence of polio in Cameroon — which borders on the troubled Central African Republic — is currently one of the most concerning.

The polio eradication campaign has faced a number of significant setbacks in the past year or so, with outbreaks in the Horn of Africa — Somalia, Kenya and Ethiopia — as well as war-torn Syria.

But of the ongoing outbreaks, Dr. Bruce Aylward said the situation in Cameroon is the one which worries him the most at the moment, listing a number of reasons.

Analysis of polioviruses from Cameroon suggests they have been circulating unchecked and undetected for at least a couple of years. Several recent nationwide vaccination campaigns have not appeared to halt the spread. And viruses from Cameroon have spread to neighbouring Equatorial Guinea.

That highlights the risk of further spread to another neighbour, the Central African Republic, where ethic-inspired killing is raising the spectre of another Rwanda. This week the United Nations agreed to send a nearly 12,000-person-strong peacekeeping force to the country.

"You sure as hell don't want (the Central African Republic) to get reinfected," said Aylward, a native of Newfoundland who is the World Health Organization's assistant director general for polio, emergencies and country collaboration.

Aylward was in Ottawa this week bringing Canadian officials up to speed on the shape of the ongoing eradication effort. A longtime donor to the effort, last year Canada pledged $250 million for the 2013-18 period. This week the federal government threw in an extra $3 million, to help with the effort to extinguish the outbreak in the Horn of Africa.

To date this year there have been 56 confirmed polio cases, three times as many as were seen last year at this time. Most of the cases — 43 — have occurred in Pakistan, one of three countries where polio remains endemic. (That means the country has never stopped transmission of the virus within its borders.)

The other two countries on the endemic list are Nigeria, which has only had one case so far this year, and Afghanistan, which has had four. For quite a while, most of the cases in Afghanistan have been caused by viruses that had come over the border from Pakistan.

"I would bet money that if Afghanistan did not share a border with Pakistan it would stop transmission this year, or be very, very close," Aylward said.

Pakistan, though, remains a major problem for the eradication effort, a partnership of the WHO, UNICEF, Rotary International, the U.S. Centres for Disease Control and the Bill and Melinda Gates Foundation.

Repeated and sometimes fatal attacks on vaccination teams have plagued efforts to get vaccine to children. And vaccination efforts have been halted in Waziristan, a conservative tribal region in the west of the country, bordering on Afghanistan.

Aylward said there is intense transmission of polio in Waziristan, which poses "a huge risk for both national and international spread."

source: www.thestarphoenix.com

AS global temperature continues to rise due to climate change so are diseases. "Climate change endangers human health," declares Dr. Margaret Chan, the director general of the Geneva-based World Health Organization (WHO).

"Without effective action, climate change is going to be larger and more difficult to deal with than we thought," said Dr. Chris Field, who was a coordinating lead author of the report issued by the Nobel-winning Intergovernmental Panel on Climate Change (IPCC).

Health scientists pointed out that should earth's thermostat continues to rise, human health problems will also become more frequent and severe.

"The warming of the planet will be gradual, but the effects of extreme weather events will be abrupt and acutely felt," Chan said. "Both trends can affect some of the most fundamental determinants of health: air, water, food, shelter and freedom from disease."

Dr. Paul Epstein, in a recent study entitled Human Health and Climate Change, said that a warming climate, compounded by widespread ecological changes, may be stimulating wide-scale changes in disease patterns.

According to him, climate change could have an impact on health in three major ways by: creating conditions conducive to outbreaks of infectious diseases; increasing the potential for transmissions of vector-borne diseases and the exposure of millions of people to new diseases and health risks; and hindering the future control of disease.

A fact sheet released by the United Nations health agency pointed out this fact: "Climatic conditions strongly affect water-borne diseases and diseases transmitted through insects, snails or other cold-blooded animals."

Take the case of dengue fever, most common mosquito-borne viral disease of human beings. Before 1970, only nine countries had experienced severe dengue epidemics. The disease is now endemic in more than 100 countries, with Southeast Asia and the Western Pacific regions as among the most seriously affected. According to the WHO, there may be 50 to 100 million dengue infections worldwide every year.

Diseases that used to be controlled are now back. In 2011 at least 158,000 people from around the world— mostly children under the age of five— died of measles. "More than 95 percent of measles deaths occur in low-income countries with weak health infrastructures," WHO deplored.

In the Philippines, measles is back in the news because of the astounding number of new cases. In fact, the Department of Health declared measles outbreaks in five cities in Metro Manila.

Weather-related problems like floods, drought, too much water, and water scarcity are most likely to bring health problems, too.

In recent years, floods have been increasing in frequency and intensity. "Floods contaminate freshwater supplies, heighten the risk of water-borne diseases, and create breeding grounds for disease-carrying insects such as mosquitoes. They also cause drownings and physical injuries, damage homes and disrupt the supply of medical and health services," the WHO fact sheet said.

"Increasingly variable rainfall patterns are likely to affect the supply of fresh water," the WHO fact sheet said. "A lack of safe water can compromise hygiene and increase the risk of diarrheal disease, which kills 2.2 million people every year."

In extreme cases, water scarcity leads to drought and famine. "By the 2090s, climate change is likely to widen the area affected by drought, double the frequency of extreme droughts and increase their average duration six fold," the UN health agency added.

Climate change also means disaster. WHO estimated some 600,000 deaths occurred worldwide as a result of weather-related natural disasters in the 1990s; some 95 percent of these were in poor countries.

Another effect of climate is sea level rise. "Rising sea levels and increasingly extreme weather events will destroy homes, medical facilities and other essential services," the WHO said. "More than half of the world's population lives within 60 kilometers of the sea. People may be forced to move, which in turn heightens the risk of a range of health effects, from mental disorders to communicable diseases."

Epstein predicts that "wide swings in weather patterns may become the norm, as sea surfaces and deeper waters continue to absorb and circulate the heat accumulating in the troposphere. At the same time, abrupt changes in climate—hopefully small enough to provide a warning and without widespread disruption—may be in store.'"

In conclusion, he pleads: "We cannot afford to continue 'business-as-usual'! Changing course will not be easy, but it is necessary. There are costs associated with acting now to slow global warming. However, in terms of future health care, productivity, international trade, tourism, and insurance costs, the savings could be huge."

source: businessmirror.com.ph

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

'Cradle to Grave'

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

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

'Gatekeepers' of the system

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

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

Function of the Puskesmas

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

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

source: www.globalindonesianvoices.com

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

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

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

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

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

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

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

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

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

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

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

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

source: www.thejakartaglobe.com

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

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

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

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

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

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

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

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

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

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

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

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

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

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

source: www.thejakartapost.com

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

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

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

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

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

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

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

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

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

source: www.thejakartapost.com