UN backs Filipino leader in contraceptives battle

MANILA, Philippines—The United Nations on Sunday expressed its support for a proposed law that would provide Philippine government funding for contraceptives and has pitted the popular president against the influential Roman Catholic church.

The bill promotes contraceptive use in a poor country with one of Asia’s fastest-growing populations. The House of Representatives plans to decide Tuesday whether to end debate on the bill and put it to a vote, reigniting acrimony over an issue that has divided Asia’s largest Roman Catholic nation for years.

Catholic bishops led a rally on Saturday by thousands of followers urging the bill’s rejection and attacking President Benigno Aquino III for supporting it. An archbishop, Socrates Villegas, urged Aquino to focus on his promise to eradicate corruption and poverty and not promote “a culture of contraception” that “looks at babies as reasons for poverty … a mistake and not a blessing.”

The bill’s supporters plan to hold their own rally Monday outside Congress.

Aquino’s camp said Sunday he would not back off from supporting the Reproductive Health bill, which he promoted in his state of the nation address in Congress last month.

The United Nations said in a statement issued in Manila on Sunday that the bill, which aims to promote responsible parenthood and teach reproductive health in schools, would help reduce an alarming number of pregnancy-related deaths, prevent life-threatening abortions and slow the spread of AIDS.

“As in many other countries where similar policies have been introduced, enacting a law that would address the reproductive health needs of the Filipino people would, over time, vastly improve health and quality of life and support development,” the U.N. said.

Countering a church argument that contraceptives foster abortions, which are outlawed in the Philippines, the U.N. said that by preventing unintended pregnancies, “a reproductive health law would help prevent recourse to life-threatening abortions.”

It said the country’s rapid population expansion could prevent millions of Filipinos from being lifted out of poverty, adding that “hopes of future prosperity could turn to dust” if the Philippines is unable to deal with the issue.

The bill pending in Congress would require the government to provide information on family planning methods, make contraceptives like condoms available free of charge to poor couples and introduce reproductive health and sexuality classes in schools. It would encourage families to limit their children to two.

Filipino church officials have blocked the passage of birth control legislation in past years, arguing that contraceptives are as sinful as abortions. Proponents of the bill want more openness toward birth control to prevent disease and reduce population growth.

Aquino, still popular after his 2010 landslide election victory, has backed birth control even if it means going against the dominant Catholic church. He said last year he was ready to face the consequences and risk excommunication if necessary. (boston.com)

Menuju Jaminan Kesehatan Semesta

Jaminan kesehatan kedepan akan mencakup seluruh rakyat Indonesia. Semua penduduk wajib ikut dan wajib bayar iuran, sedang yang tidak mampu iurannya dibayar Pemerintah.

Adalah suatu keharusan, Badan Penyelenggara Jaminan Sosial (BPJS) bidang kesehatan akan dilaksanakan mulai 1 Januari 2014 mendatang. Langkah ini akan memuluskan jalan Indonesia menuju Jaminan Kesehatan Semesta (JKS) atau Universal Health Coverage (UHC).

Namun, upaya ini tidaklah mudah. Kalau bicara tentang UHC, paling tidak ada tiga dimensi yang harus dipenuhi. Pertama, seberapa luas cakupan peserta yang akan dijamin. Kemudian, seberapa dalam manfaat pelayanan kesehatan yang akan dijamin. Terakhir, seberapa besar proporsi urun biaya yang masih harus dikeluarkan oleh peserta jaminan kesehatan ketika mendapatkan manfaat.

Idealnya, ketiga dimensi itu harus terpenuhi. Namun, mengingat keterbatasan yang ada, tidak mungkin memenuhi ketiga dimensi tersebut secara bersamaan di awal penyelenggaraan jaminan kesehatan nasional. Oleh karenanya, Pemerintah memprioritaskan upaya perluasan cakupan kepesertaan terlebih dahulu, tetapi tetap dengan memperhatikan kedua dimensi yang lain.

Menurut Wakil Menteri Kesehatan RI Ali Ghufron Mukti, sebenarnya Pemerintah, dalam hal ini Kementerian Kesehatan sejak 2009 menginginkan seluruh masyarakat itu memiliki jaminan kesehatan pada tahun 2014. Namun, terkendala dengan belum adanya Badan Penyelenggara dan peraturan terkait lainnya. Dengan telah diundangkannya UU No. 24 tahun 2011 tentang BPJS, maka upaya untuk mencapai kepesertaan jaminan kesehatan nasional itu akan diakselerasi.

“Kami berkeinginan secepat mungkin penduduk Indonesia itu bisa mengakses pelayanan kesehatan tanpa beban biaya besar dan bisa mencapai derajad kesehatan yang setinggi-tingginya,” ujar Wamenkes.

Selain itu, pencapaian JKS saat ini sudah menjadi prioritas global. Hal tersebut menjadi tema utama pada World Health Assembly ke-65 di Jenewa, yang berlangsung tanggal 21-26 Mei 2012 lalu. Upaya pencapaiannya sama pentingnya dengan pencapaian sasaran dalam Millenium Development Goals (MDGs). UHC ini bisa menjadi salah satu indikator penting untuk mengukur sejauh mana kinerja Indonesia dalam menjamin kesehatan penduduknya. Bahkan kemungkinan akan menjadi prioritas global pada era setelah prioritas MDGs berakhir.

MEMPERLUAS CAKUPAN

Saat ini sekitar 63,5 persen penduduk Indonesia atau 151,5 juta jiwa telah mempunyai jaminan kesehatan dengan berbagai cara penjaminan. Itu termasuk para peserta Jamkesmas, Jamkesda, Askes, PNS Pensiunan dan Veteran, TNI POLRI aktif, Jamsostek, jaminan oleh perusahaan dan individu peserta jaminan kesehatan dari perusahaan asuransi kesehatan swasta. Artinya, masih terdapat 37 persen penduduk atau 87 juta jiwa yang belum tercakup dalam jaminan kesehatan.

Menurut Wamenkes, Pemerintah memiliki target untuk mencapai UHC secepatnya. Jika memungkinkan, akhir 2014 nanti minimal bisa mencakup 71 persen penduduk atau 174,5 juta jiwa. Artinya, mulai sekarang sampai dengan akhir 2014 harus ada upaya untuk meningkatkan kepesertaan sebesar 7 persen penduduk atau sekitar 23 juta jiwa.

Penambahan peserta sebesar 23 juta jiwa sampai dengan 2014 itu rencananya meliputi 19,6 juta jiwa dari peserta Penerima Bantuan Iuran (PBI) dan 3,4 juta jiwa peserta dari kelompok pekerja penerima upah yang pada saat ini masih belum mempunyai jaminan kesehatan.

Untuk menambah cakupan peserta, Pemerintah akan terus mendorong kepesertaan pekerja penerima upah (formal) yang diperkirakan jumlah totalnya mencapai 70 juta jiwa. Saat ini pekerja formal yang menjadi peserta Jamsostek baru mencapai 6 jutaan, dan yang mendapat jaminan dari perusahaan mencapai 15 jutaan.

Selain itu, Pemerintah juga akan menambah jumlah peserta PBI. Peserta PBI adalah peserta jaminan kesehatan yang iurannya dibayar oleh Pemerintah. Saat ini ada 76,4 juta peserta PBI melalui Program Jaminan Kesehatan Masyarakat (Jamkesmas). Untuk peserta PBI tahun 2013, Pemerintah menambah jumlah sasarannya menjadi 86,4 juta jiwa. Tahun 2014 diharapkan jumlah peserta PBI mencapai 96 juta. Data sasaran PBI ini telah tersedia sesuai hasil identifikasi TNP2K bersama BPS.

KEPESERTAAN DAN IURAN

Kepesertaan Jaminan Kesehatan ini bersifat wajib. Jadi, seluruh masyarakat di Indonesia harus ikut program jaminan kesehatan ini. Diharapkan Jaminan Kesehatan telah mencapai kepesertaan semesta atau Universal Health Coverage (UHC) paling lambat pada tahun 2019.

Dengan semua penduduk menjadi peserta jaminan kesehatan akan terjadi subsidi silang antara peserta yang sehat kepada yang sakit, peserta yang muda kepada yang tua, dan peserta yang kaya kepada yang miskin. Dan, yang penting diketahui masyarakat, jaminan kesehatan ini tidak gratis. Prinsipnya semua orang yang akan menjadi peserta jaminan kesehatan wajib membayar iuran.

Bagi pekerja penerima upah (pekerja swasta, PNS, TNI POLRI aktif, pensiunan dan veteran) iurannya ditanggung oleh pekerja dan pemberi kerja.

Lantas bagaimana dengan kelompok masyarakat miskin dan tidak mampu membayar iuran? Mereka iurannya akan dibayar oleh Pemerintah sebagai peserta PBI. Adapun penetapan kepesertaan PBI akan ditetapkan melalui Peraturan Pemerintah yang rancangannya kini tengah terus dimatangkan.

Sedangkan besaran iuran bagi peserta PBI dan proporsi iuran yang ditanggung oleh pekerja dan pemberi kerja saat ini masih terus digodok dan akan ditetapkan melalui Peraturan Presiden yang rancangannya masih sedang disiapkan.

Sementara itu, bagi pekerja bukan penerima upah yang tidak terkena wajib pajak diusulkan masuk dalam PBI. Secara teknis, sulit untuk mengumpulkan iuran dari kelompok pekerja bukan penerima upah. Terlebih sistem pembayaran pajak yang ada saat ini masih belum mencakup seluruh pekerja. Bisa jadi biaya untuk mengumpulkannya sama besarnya dengan besaran iuran itu sendiri.

Namun demikian, menurut Wamenkes, pada saatnya nanti Indonesia akan mencapai kondisi dimana sistem pembayaran pajak makin baik. Dengan begitu, kelompok pekerja bukan penerima upah ini secara bertahap akan membayar sendiri iurannya. Tentunya setelah semua sistem pembayaran telah disiapkan dengan baik oleh BPJS dan besaran biaya mengumpulkan iuran sudah efektif. Di sisi lain untuk pekerja bukan penerima upah namun menjadi wajib pajak akan dicarikan jalan keluarnya. (news.okezone.com)

SBY Tells Indonesians To Stop Seeking Medical Treatment Abroad

President Susilo Bambang Yudhoyono told wealthy Indonesians stop heading overseas for medical treatment in a criticism of medical tourism delivered at the Health Ministry on Wednesday.

“Honestly, I’m not happy if our people go abroad for medical treatment because it only benefits neighboring countries,” Yudhoyono said.

Indonesia’s ministers need to set an example for the rest of the nation and only seek treatment at domestic health facilities, he said. It is a policy Yudhoyono says he has followed for years.

But he may be in the minority among Indonesians with the means to seek treatment at hospitals and health centers overseas. According to the Health Ministry, some 600,000 Indonesians leave the country for medical treatment every year. They spend an estimated $1.2 billion on treatment in nations with modern, and often better-equipped, health facilities.

Among those who sought medical care overseas was Yudhoyono’s own wife, Ani Yudhoyono. The first lady traveled to the United States in June to undergo treatment for a nerve problem in her neck at Allegheny General Hospital in Pittsburgh, Pennsylvania.

“He feels concerned by the many Indonesians who seek medical treatment overseas, but the First Lady herself sought medical attention abroad,” said the Golkar Party’s Poempida Hidayatullan, a member of the House Commission IX that deals with health affairs.

Indonesia needs to change the perception of the nation’s doctors, who have the necessary skills and knowledge to treat citizens here, Poempida said.

“For me, the perception that domestic health care is not that good is clearly because of an inappropriate and unintegrated policies and strategies in the health sector,” he said.

The lawmaker urged the president to push for health care reform and a larger budget in an effort to boost the system’s efficiency.

“This should encourage the development of the national health sector and this should have the president’s special attention,” Poempida said.

Yudhoyono told a crowd of reporters and Health Ministry officials on Wednesday that he was committed to continuing the development of the nation’s health system. He also asked those thinking of heading overseas to consider scheduling an appointment at a domestic hospital instead.

“Our quality [hospital] and doctors are something to be proud of,” Yudhoyono said. “Many of our doctors are smart and recommended by other countries.”

But for those who still plan to leave Indonesia for treatment, there is little the president can do to stop them, he said.

“I could not forbid them, as I could not issue presidential decree banning our people from seeking medical help abroad,” Yudhoyono said. (thejakartaglobe.com)

RI research needs private sector: Expert

Paper Edition | Page: 4

Universities need to work with the private sector in their biotechnology research, otherwise their work will not reach the market and bring advantages to the public, a health expert has said.

Amin Soebandrio, a health expert with the Research and Technology Ministry, said any biotechnology research conducted by universities would languish in the laboratory if they did not work with manufacturing companies.

Pharmaceutical companies believed biotech products would not bring them commercial benefits but research by universities would change such assumptions, he said.

“In conducting biotechnology research, universities should work closely not only with the government but also with the private sector as they are the only ones who know what consumers need most,” said Amin, who is also a microbiology scientist.

Through such partnerships, he said, universities could obtain research funding from the private sector for developing applicative products while the industry could get quality research for creating products for commercial markets.

Amin made the remarks on the sidelines of a gathering discussing the 2012 Local Biotechnology Leadership Camp (Biocamp), a competition held to select young researchers particularly in biotechnology development and biomolecular medicine.

Two researchers Reswita Dery Gisriani of the Bandung Institute of Technology (ITB) and Dodi Hamdani Sukiman of the PPM School of Management were selected for the competition. Reswita and Dodi will participate in the 2012 International Biocamp to be held from Aug.26 to 29 in Basel, Switzerland.

Reswita emphasized that biotechnology research focused on drug discovery and development. The process of translating scientific research to the manufacturing of drugs, vaccines or diagnostic tools was quite complicated, she added.

“It is a fact that only a few pharmaceutical companies are interested in developing research and technology on biotech drugs. Thus, it affects our efforts in working on biotechnology research,” she told The Jakarta Post.

With the growing number of diseases – particularly those with limited medication choices such as age-related macular degeneration (AMD), health workers will need support from biotechnology research in the challenges that can no longer be dealt with through conventional medication.

With biotechnology research, proper diagnostic methods can be developed, enabling them to detect illnesses more accurately.

“Proper diagnostic tools are very important in particular to avoid mistakes in treatment of patients with the new types of diseases,” said Reswita, who proposed the idea to improve people’s access to quality biotechnology medicine by increasing the involvement of the private sector in social protection schemes delivered by the government during the July 4 qualifying contest. (thejakartapost.com)

Kapasitas Terbatas, Pasien Melonjak

Jakarta – Jelang diberlakukannya Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan 1 Januari 2012 mendatang, diperkirakan bakal terjadi lonjakan jumlah pasien karena semua orang bisa berobat gratis.

Ketua Dewan Jaminan Sosial Nasional (DJSN), Dr. Chazali H Situmorang, Apt, MSc, dalam diskusi ‘Transformasi BPJS, sampai di mana?’ bersama Forum Wartawan Kesra (Forwara), Selasa di Jakarta. (aby)

“Untuk mengantisipasi lonjakan pasien, sementara kapasitas sarana kesehatan terbatas, pemerintah harus segera mendekati pihak swasta agar berinvestasi dan membangun berbagai fasilitas kesehatan,” ujar Ketua Dewan Jaminan Sosial Nasional (DJSN), Dr. Chazali H Situmorang, Apt, MSc, dalam diskusi ‘Transformasi BPJS, sampai di mana?’ bersama Forum Wartawan Kesra (Forwara), Selasa (31/7) di Jakarta.

Menurut Chazali, meski Kementerian Kesehatan tidak bisa mengatur rumah sakit swasta, namun BPJS dapat bekerjasama dengan semua jenis rumah sakit, baik swasta maupun milik negara.

“Undang-undang menyatakan, rumah sakit manapun harus menyediakan layanan komprehensif, mulai dari promotif, preventif, kuratif, dan rehabilitatif,” ujarnya.

Chazali mengatakan, dengan dana terbatas, pemerintah tidak akan bisa mengantisipasi lonjakan ini. “Puskesmas kita terbatas, kalau mau dipaksakan, tetap saja anggaran pemerintah terbatas. Saya dengar tahun 2013 anggaran untuk fasilitas kesehatan hanya akan ditambah Rp1 triliun, berarti sangat terbatas,” urainya.

Chazali mengatakan pemerintah harus meyakinkan pihak swasta untuk membangun rumah sakit di tempat-tempat yang disetujui pemerintah. Pihak swasta diberi kemudahan perijinan. Asal jangan membangun RS di Ibukota Jakarta karena sudah kelebihan supply.

Dia mengatakan pihak swasta harus dibuat tertarik berinvestasi, karenanya pemerintah harus mempermudah semua perijinan. “Pemda harus sediakan lahan, sediakan sumber daya manusianya, kirim dokter-dokter ke sana,” katanya lagi.

Menurut Chazali dengan pertimbangan menarik investor swasta pula maka diharapkan iuran jaminan kesehatan sebesar Rp27.000, jauh lebih besar dibanding iuran Jaminan Kesehatan Masyarakat (Jamkesmas) yang hanya Rp6.500 per orang per bulan.

Chazali memperkirakan, pada Januari 2013 sebanyak 130 juta rakyat Indonesia sudah memiliki jaminan kesehatan yang mencakup semua jenis penyakit seumur hidup. Diharapkan di tahun 2019 semua rakyat Indonesia sudah menjadi anggota BPJS.

Chazali mengatakan, jika disepakati iuran jamkes sebesar Rp27.000 ribu maka diperkirakan dalam satu tahun Indonesia akan mendapat dana kesehatan sebesar Rp31 triliun.

“Angka Rp31 triliun itu relatif tidak besar dibanding sekitar Rp1400 triliun APBN saat ini. Apalagi jika mempertimbangkan aspek kesehatan sebagai investasi kemajuan bangsa,” kata Chazali.

Menurutnya, program kesehatan tidak hanya aspek kuratif, tetapi juga promotif dan preventif. Karenanya, pelaksanaan program jaminan kesehatan akan tergantung pada kesediaan pemerintah untuk mengucurkan dana ini. “Jangan melihat orang miskin sebagai beban. Jika ingin mereka membayar, jadikan mereka aset masa depan bangsa agar tidak miskin lagi,” tegasnya.

Pelaksanaan jaminan kesehatan oleh BPJS Kesehatan sejauh ini dinilai Chazali tidak terlalu menghadapi masalah. Karenanya, ia yakin pada 2014 BPJS Kesehatan bisa langsung ‘berlari’.

Drg. Moeryono Aladin, menambahkan, meski ini wajib, masyarakat mampu boleh saja mengikuti jaminan kesehatan lain. Di sini lah letak sistem gotong royong BPJS Kesehatan.

“Iurannya wajib bagi semua masyarakat, tapi bagi masyarakat mampu yang tidak mau menerima manfaat dari BPJS Kesehatan, ya diperbolehkan,” ujarnya.

Ia memastikan, pengelolaan BPJS Kesehatan tidak akan dikuasai asing. Sebagai amanat UU No. 24 tahun 2011 tentang BPJS, maka pihak-pihak asing tidak ada celah untuk menguasai BPJS ini.

“Lain lagi ceritanya kalau masyarakat ingin menggunakan asuransi komersial milik asing,” tambahnya.

Jika BPJS Kesehatan tidak ada masalah pada 2014, lain halnya dengan BPJS Ketenagakerjaan. Variabel permasalahan di ketenagakerjaan lebih kompleks dibandingkan kesehatan, dengan empat program dan skema yang berbeda.

“Sejauh ini masih terus dibahas mengenai porsi iuran yang dibayarkan antara pemberi kerja dan pekerja,” tambah Chazali.

Dalam program Jamsostek selama ini yang membayar iuran adalah pemberi kerja. Namun, ini sebesarnya dana dari pekerja. Cuma soal teknis administrasi dan secara akuntansi saja.

Menjelang 2015, satu hal yang paling mendesak dalam Jaminan Sosial Ketenagakerjaan yakni jaminan pensiun. “Ini tidak boleh ditunda karena akan ada lost opportunity, padahal ada sekitar 120 juta orang angkatan kerja di Indonesia. (poskotanews.com)

Traditional cures provide economic benefits

Harvard researcher finds the use of traditional, natural medicines offer economic benefits

For millions of people around the world being sick doesn’t mean making a trip to the local pharmacy for medicines like Advil and Nyquil. Instead it means turning to the forest to provide a pharmacopeia of medicines to treat everything from tooth aches to chest pains.

But while questions persist about whether such natural remedies are as effective as their pharmacological cousins, one Harvard researcher is examining the phenomenon from a unique perspective, and trying to understand the economic benefits people receive by relying on such traditional cures.

As reported in a paper published this week in PLoS ONE, Christopher Golden, ’05, a Post-Doctoral Fellow at the Harvard University Center for the Environment has found that, in the area of northwest Madagascar he studies, people annually receive between $5 and $8 in benefits by using natural medicines.

Though seemingly slight, those benefits add up to between $30 and $45 per household, Golden said, or anywhere from 43 to 63 percent of the median annual income for families in the region.

“We documented people using more than 240 different plant species to treat as many as 82 different illnesses,” Golden said. “This data suggests that it can have quite an impact, financially.”

It’s an impact that may not be limited to Madagascar, or other regions where access to pharmaceuticals is limited.

As part of his analysis, Golden also compared the use of natural remedies with the prices that American consumers might pay if they were purchasing the pharmaceutical equivalent online – where prices are typically lower than on pharmacy shelves. To his surprise, the results showed that the average American could save anywhere from 22 to 63 percent of their annual health care bill, simply by using natural medicines.

“If Americans were relying on traditional medicines as much as people in Madagascar, it could save them a major percentage of their health care expenditures,” Golden said.

Golden, however, was quick to emphasize that his study only examined the economics of the natural remedies versus pharmaceuticals, not whether they were equally effective.

“What we’re trying to do is account for the economic value the local floral bio-diversity provides to people in this area of Madagascar,” Golden said. “We’re not assuming there is a medical equivalency – this study is about the perceived efficacy. The people who live in this region often have taken both pharmaceuticals and traditional medicines many times, but there is a perceived efficacy for these traditional medicines.”

Measuring that perceived efficacy involved surveying 1,200 households in and around Maroantsetra, a city in the northeast corner of the island nation, to determine which natural medicines they used.

To establish the economic benefit of each natural remedy, Golden asked whether people would prefer to use the natural or pharmaceutical remedy for a given illness. If, for example, 60 percent of those asked said they preferred the traditional medicine, Golden established its value as being 60 percent of the price of its pharmaceutical cousin. (News-medical.net)

Menjelang Berlakunya BPJS, Perlu Banyak RS Swasta

Dengan pemberlakuan BPJS Kesehatan Januari 2014 mendatang diperkirakan akan ada lonjakan pasien karena semua orang bisa berobat.

Ketua Dewan Jaminan Sosial Nasional, Chazali H Situmorang mengatakan pemerintah harus mulai mendekati pihak swasta untuk berinvestasi di bidang fasilitas kesehatan dalam rangka mengantisipasi pemberlakuan Badan Penyelenggara Jaminan Sosial (BPJS) 2014 mendatang.

Menurut Chazali, meski Kementerian Kesehatan tidak bisa mengatur Rumah Sakit Swasta namun Badan Penyelenggara Jaminan Sosial dapat mengadakan kerjasama dengan semua jenis rumah sakit, baik swasta maupun milik negara.

“Undang-undang menyatakan, rumah sakit manapun harus menyediakan layanan komprehensif, mulai dari promotif, preventif, kuratif, dan rehabilitatif,” ujarnya.

Chazali mengatakan, dengan pemberlakuan BPJS Kesehatan Januari 2014 mendatang diperkirakan akan ada lonjakan pasien karena semua orang bisa berobat.

Menurutnya, dengan dana terbatas, pemerintah tidak akan bisa mengantisipasi lonjakan ini.

“Puskesmas kita terbatas, kalau mau dipaksakan kan anggaran pemerintah terbatas, saya dengar tahun 2013 anggaran untuk fasilitas kesehatan hanya akan ditambah Rp1 triliun, hanya sampai di mana itu?” tanyanya.

Chazali mengatakan pemerintah harus meyakinkan pihak swasta untuk membangun rumah sakit di tempat-tempat yang disetujui pemerintah.

“Jangan lagi bangun rumah sakit di DKI Jakarta yang sudah berlebihan,” kata Chazali.

Lebih lanjut ia mengatakan agar pihak swasta tertarik berinvestasi maka pemerintah harus memberi kemudahan perizinan.

“Pemda harus sediakan lahan, sediakan sumber daya manusianya, kirim dokter-dokter ke sana,” katanya lagi.

Menurut Chazali dengan pertimbangan menarik investor swasta pula maka diputuskan iuran jaminan kesehatan sebesar Rp 17.000, jauh lebih besar dibanding iuran Jaminan Kesehatan Masyarakat (Jamkesmas) yang hanya Rp6.500 per orang per bulan.

Chazali memperkirakan, pada Januari 2013 sebanyak 130 juta rakyat Indonesia sudah memiliki jaminan kesehatan yang mencakup semua jenis penyakit seumur hidup.

Diharapkan di tahun 2019 semua rakyat Indonesia sudah menjadi anggota BPJS.

Chazali mengatakan, jika disepakati iuran jamkes sebesar Rp27.000 ribu maka diperkirakan dalam satu tahun Indonesia akan mendapat dana kesehatan sebesar Rp79 triliun. (beritasatu.com)

World Hepatitis Day

The silent nature of viral hepatitis infection has an enormous impact on the capacity and willingness of governments across the world to develop and implement effective policy and health responses to these diseases.

The burden of viral hepatitis is stark, particularly in Asia Pacific where the prevalence is greatest, with approximately 340 million people living with chronic hepatitis B and hepatitis C. This is almost eight times the number of people in the region infected with HIV, tuberculosis (TB) or malaria (42 million). In 2011, the World Health Organisation’s (WHO) south-east Asia office reported there are 120,000 deaths annually related to hepatitis C and 300,000 related to hepatitis B.

Viral hepatitis is a significant health problem, but its silent nature – there are no symptoms in the early phases, so people are often unaware that they are infected with hepatitis B and C until it is too late – has meant that the diseases have not had the same global and regional response as HIV, TB and malaria, and this lack of co-ordination continues to undermine global health efforts.

In 2010, there were signs that things were changing, with the agreement of a resolution on viral hepatitis by the World Health Assembly, but its implementation to date has been slow and unco-ordinated. Ahead of World Hepatitis Day on Saturday, this week’s publication of a global framework by WHO is another important milestone, but it runs the risk of failing to deliver if the denial that exists around chronic hepatitis, among individuals and in health systems, is not addressed.

Hepatitis B, which is transmitted from mother to child or through bodily fluids, is prevented with a safe and effective vaccine. There has been some recent good news from China, which successfully reduced the number of children under five with hepatitis B from 5.5% in 1992 to less than 1% in 2005, according to WHO.

But there remain huge barriers for implementing vaccination programmes among babies and young people in the region. Although there is access to vaccines, the implementation can be problematic where there are fundamental weaknesses in health systems. In countries such as Papua New Guinea or Laos there are simply not the health services nor workers available to carry out vaccinations.

For most people with viral hepatitis, the infection has no obvious symptoms, meaning that their disease is likely to progress to a point where treatment has limited impact. Most people with viral hepatitis do not know they are infected. Even in countries such as Taiwan and Australia where hepatitis is recognised as a priority health issue, a sizeable proportion of people are yet to be diagnosed.

There are systemic barriers to testing in many countries in the region such as Vietnam, Singapore, Philippines, or Thailand where people are required to pay for testing. This essentially limits the number of people who know they are infected and the ability to reduce the impact of infection.

Hepatitis B infection is complex, and liver damage as a result of the infection occurs over many years. Most people with chronic hepatitis B will not require treatment, but will need to be monitored to identify when liver damage is taking place. Only about 15-25% of people need to receive treatment for the infection.

However, for people who do know that they have the infection, access to health services can be an issue. Of the 300,000 to 400,000 people living with chronic hepatitis B in Hong Kong, 80,000-90,000 people (25%) need treatment, and only half are being treated

Like many 21st-century health issues, viral hepatitis knows no borders. Migration and other movements of people mean that comprehensive and co-ordinated responses to the infection within and across countries are imperative if the burden of infection is to be reduced or eliminated.

In collaboration with the Australian Research Centre in Sex, Health and Society at La Trobe University, the Coalition for the Eradication of Viral Hepatitis in Asia Pacific (Cevhap) has developed a research plan to assist countries and the World Health Assembly to identify the essential elements of a strategic response to chronic viral hepatitis. This work is under way, with assessment of the policy in Taiwan, a needs assessment of people with chronic viral hepatitis across five locations in China, and support for the facilitation of partnership development initiatives in Malaysia and India.

Lessons from other international health issues such as HIV can support the development of effective policy and health responses to viral hepatitis. One lesson is the importance of broad-based partnerships in policymaking, something that has been woefully lacking in Asia. More important, however, is the need for WHO to establish a sustainable mechanism for international funding and implementation of the new global framework and the newly formed Global Hepatitis Programme, similar to those that exist for HIV, TB and malaria.

An effective policy framework can prevent new infections, ensure people can access clinical care, and reduce the burden of infection at an individual, country and regional level. That will only be possible if funding is increased considerably. The global response provided by UNAids, the Stop TB Partnership and the Rollback Malaria Partnership show what can be achieved if governments, the medical community, donor organisations and civil society work together.

Viral hepatitis can be eliminated with resources, co-ordination and willingness, but, as the world recognises the second WHO-endorsed World Hepatitis Day, a lack of funding remains the single greatest barrier to tackling these diseases. (healthcanal.com)

Rokok Membodohi Masyarakat

JAKARTA (Pos Kota) – Indonesia terus menjadi tertawaan pegiat anti rokok internasional. Dari seluruh negara di Asia Tenggara, Indonesia dinilai paling bebas mengedarkan dan mengebulkan asap rokok di mana pun. Rokok membuat masyarakat Indonesia bodoh.

Padahal negara tetangga Singapura saja menerapkan aturan sangat ketat terhadap industri rokok agar penduduknya terhindar dari racun rokok mematikan.

Pegiat antirokok internasional, Dr Stephen Carr Leon melihat rokok bisa menjadi alat pembodohan suatu bangsa dan negara. “Dan rokok melahirkan suatu generasi bodo.

“Lihat saja Indonesia. Jika Anda ke Jakarta, atau wilayah manapun di Indonesia, di mana saja Anda berada, dari restoran, teater, kebun bunga hingga ke musium, hidung Anda akan segera mencium bau asap rokok! Berapa harga rokok? Cuma 70 cent (Rp9000),” sesalnya.

Padahal di Singapura harga sebungkus rokok mencapai Rp80 ribu. Di Malaysia Rp65 ribu, di Thailand Rp50 ribu dan di Filipina Rp55 ribu. Artinya, pemerintah Indonesia tidak melindungi warganya dari bahaya racun nikotin.

Menurut dia, Indonesia menduduki peringkat ketiga di dunia dalam hal jumlah perokok. Sekitar 80 juta penduduk Indonesia merokok. Kematian akibat penyakit yang berhubungan dengan rokok tiap tahun mencapai 629.948 orang atau 1.372 orang per hari. Bahkan, kerugian akibat rokok melebihi pendapatan cukai. Tahun 2011 cukai rokok sebesar Rp62 triliun. Tetapi biaya pengobatan penyakit akibat rokok mencapai Rp310 triliun atau 5 kali lipat cukai rokok. Konsumsi rokok tahun 2008 mencapai 240 miliar batang per hari atau 658 juta batang per hari. Ini berarti 330 miliar ‘dibakar’ oleh perokok Indonesia dalam sehari.

CANDU WARGA MISKIN

Wakil Menteri Kesehatan (Wamenkes) Prof. Dr. Ali Ghufron Mukti, MSc, PhD menuturkan pendapatan yang dihabiskan orang miskin untuk membeli rokok sebesar 19 persen. Sementara itu biaya kesehatan, warga miskin hanya menghabiskan 2,5 persen dari total pengeluarannya.

“Untuk orang miskin, sekitar 11-19 persen uangnya habis untuk rokok, sedangkan untuk kesehatan dia cuma 2,5 persen Kalau mereka kemudian bisa tidak merokok, uang yang 19 persen itu tidak lagi keluar,” ungkap Gufron.

Dia mengakui, pemerintah terus mengkampanyekan antirokok, agar masyarakat cenderung berperilaku hidup sehat. “Kita berpromosi agar warga berperilaku hidup sehat, tidak terkena penyakit kanker paru dll. Kongkretnya kita terus berpromosi lintas sektor, dengan LSM dengan Puskesmas,” katanya.

Gufron mengatakan, pihaknya berupaya pengesahan Rancangan Peraturan Pemerintah (RPP) tembakau agar segera dilaksanakan. “Termasuk mengupayakan RPP Tembakau disahkan secepat mungkin, kemudian kita buat klinik juga,” tambahnya.

Data dari Badan Pusat Statistik menyebutkan sumbangan beras, rokok hingga belanja untuk perumahan dan pendidikan masih menjadi penyumbang utama kemiskinan. Jika pengeluaran salah satu komoditi itu ditekan maka, jumlah kemiskinan bisa dikurangi.

“Kalau kampanye anti rokok bisa dijalanin itu bisa mengurangi kemiskinian juga, karena rokok termasuk pengeluaran walau tak ada kalori,” kata Kepala BPS Suryamin, kemarin. (postkotanews.com)

Study reveals substantial misdiagnosis of malaria in parts of Asia

The authors warn that with more than two billion people at risk of malaria in this part of Asia – larger than that of Africa – this is a major public health problem which needs to be confronted.

The study was published in the BMJ.

Malaria remains one of the most important infectious diseases of poverty. Recent global malaria treatment guidelines recommend that patients are treated with anti-malaria drugs only when a diagnostic test positively identifies malaria parasites in the patient’s blood.

In Africa, many patients are treated for malaria even when the parasite test is negative, resulting in other severe infections being missed and drugs being wasted. Yet the extent of this problem in south and central Asia is relatively unknown.

A team of researchers from the School therefore set out to assess the accuracy of malaria diagnosis and treatment for over 2,300 patients with suspected malaria at 22 clinics in northern and eastern Afghanistan.

Some clinics used microscopic diagnosis, while others relied on clinical signs and symptoms to diagnose malaria.

Blood sample slides were collected for every patient as a reference slide which was read by two independent experts who recorded whether the slide was positive or negative for malaria. This reference result was compared to the result of the diagnosis at the clinic and the treatment given to each patient.

In clinics using clinical diagnosis where malaria is rare, 99% of patients with negative slides received a malaria drug and just over one in 10 (11%) received an antibiotic.

This compares with clinics using newly introduced microscopy, where 37% of negative patients received a malaria drug and 60% received an antibiotic. In clinics with established microscopy, 51% of negative patients received a malaria drug and 27% received an antibiotic.

Almost all cases were due to vivax malaria, a relatively less serious form of malaria. However, only one in six cases of the rarer but potentially fatal falciparum malaria were detected and appropriately treated.

Compared with clinical diagnosis, microscopy improves the targeting of malaria drugs, but only by half, and it increases the prescription of antibiotics, say the authors.

They argue that misdiagnosis and treatment is caused in equal part by inaccurate microscopy and by the clinicians’ tendency to treat with malaria drugs even when a test result is negative, resulting in a 40-50% loss of accuracy in treatment. The results are comparable to findings from Africa, confirming that inaccurate diagnosis and treatment of malaria is a worldwide problem.

Lead author Dr Toby Leslie, Lecturer at the London School of Hygiene & Tropical Medicine and Project Manager of the ACT Consortium in Afghanistan, said: “Improving malaria diagnosis and treatment is central to present day efforts to reduce malaria mortality and morbidity. Our research contributes to an emerging picture of suboptimal services across the malaria endemic world. Not only does this waste limited resources but also means that many patients are not correctly treated. This has to be corrected through improving coverage and quality of diagnosis and changing practice amongst prescribers.” (healthcanal.com)