Tuesday, November 30, 2010

Children Affected With HIV/AIDS Attend Training Workshop

Today, 1st of December, is World AIDS Day—a grim reminder of this killer disease, which has devastated millions of families all over the world. In Uttar Pradesh alone, more than 35,000 AIDS patients were registered with the state AIDS Control Office till September, 2010. How many more unregistered people would there be, is anybody’s guess. Amongst the registered ones, there are 1597 male and 777 female HIV positive children. Read more


With a view to lend a helping hand, UNICEF has organized a training workshop for such children at its pavilion at the ongoing Lucknow Mahotsava—a gala, annual event, spread over 10 days.

 The first batch of child reporters and Bal Bandhus (little friends), who arrived in Lucknow on Nov 25 have already completed a very successful training in the media tools. The second batch from Lalitpur district that started their training in the five media tools of communication at UNICEF Pavilion at the Lucknow Mahotsava from Nov 30th.

This second group of children will also be joined at the UNICEF Pavilion by HIV positive affected and infected children who will be coming from six districts of Uttar Pradesh. The children will be brought in by a non-government Lucknow based organisation named  UMEED which works for the rehabilitation and welfare of children living with HIV/AIDS and is part of the workshops from Nov 30-2 Dec 2010 .

Apart from learning the five media tools from the 18 master trainers from Maharajganj who are conducting the workshop, the HIV positive children will also be celebrating the World AIDS Day today in Lucknow at the Mahotsava.

Let all of us contribute in some way or the other to keep  the spirit of these young fighters high.

Anjali Singh - CNS
(The author is a UNICEF consultant and a senior journalist. She is also the Director of Saaksham Foundation) 

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Strengthening Health Systems: Global Health Financing

A new research report "Financing Global Health 2010: Development assistance and country spending in economic uncertainty", by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, indicates that despite the worst global economic crisis in decades, public and private donors continue to donate generously to global health, though at a slower rate. The report documents the continued rise in health funding and the effects of that funding on spending for health by governments in developing countries. The commitment to health in the developing world has grown dramatically over the last twenty years, with the  developing countries' governments increasing their spending on health. Read more

 The research shows that development assistance for health has grown 375% in the last decade-- from $5.66 billion in 1990 to $26.87 billion in 2010. Thailand, for example, has seen its health assistance explode from $2.3 million in 1990 to $67.9 million in 2008-- a staggering increase of nearly 3000%. But, when we look around the region, we find countries that receive far more aid than Thailand per person, including the Philippines, Cambodia and, most strikingly, the small island nations. Micronesia, for example, receives $161 per person, while Thailand receives only $1 per person.

However, IHME’s preliminary estimates show that the growth rate is slowing. Between 2004 and 2008, assistance grew by an annual average of 13%. But between 2008 and 2010, the rate of growth was cut by more than half to 6% annually. The government and private donors in the US made up one-half of all funding in 2008. But the economic downturn has hit US-based NGOs hard, and the amount of health funding spent by them decreased by 24% from 2009 to 2010.

Most health funding has gone to the countries with the greatest need, but researchers found striking anomalies, including the fact that 11 of the 30 countries with the highest number of people suffering from disease and high mortality receive less health funding than countries with stronger economies and lower disease burdens.
Dr. Christopher Murray, Director of IHME, feels that, “Everyone in the global health community is worried about how the economic crisis is going to affect giving. Research has shown that economic downturns don’t usually have an immediate effect on charitable giving, but we were still surprised to see sustained growth through 2010.”

Spending on HIV/AIDS programs has continued to rise at a strong rate, making HIV/AIDS the most funded of all health focus areas. Dr Murray feels that this could partly be due to the fact that, "Advances in medications to combat HIV were among the main reasons that donors and NGOs started to rally together to form what we know today as the global health community. The legacy of the early fight against HIV has maintained a strong commitment to funding for HIV-related efforts, and this includes the U.S. President's Emergency Plan for AIDS Relief, the single largest amount of funding to combat HIV."

Funding for maternal, newborn, and child health received about half as much funding as HIV/AIDS as of 2008. Again, funding for non communicable diseases represents just 0.5% of all development assistance for health.

Both, malaria and tuberculosis receive far less funding than AIDS: $1.19 billion for malaria in 2008 and $0.83 billion for tuberculosis. Funding for malaria and tuberculosis also appears to go to countries that do not have large groups at risk for these diseases. For example, of the 30 countries that receive the most malaria health funding adjusted for disease burden, only three – Eritrea, Sao Tome and Principe, and Swaziland – are located in sub-Saharan Africa, where malaria is most acute. Instead, the countries that receive the most money in proportion to their malaria burden include Georgia, Sri Lanka, Azerbaijan, Uzbekistan, Nicaragua, Kyrgyzstan, Tajikistan, Honduras, and Guatemala. All of these countries received more than $2,000 per disability-adjusted life year, or DALY, between 2003 and 2008.

Why is it so? Dr Murray feels that “in part it’s because health assistance decisions are not made entirely based on need but also reflect longstanding economic and political ties between countries, some of which go back to colonial days.”

In countries whose governments receive significant donor funding, development assistance for health appears to be partially replacing domestic health spending instead of fully supplementing it. Conversely, in countries that receive health funding mainly through NGOs, government health spending appears to increase.

The researchers indicate that the intensified focus on certain health issues – such as maternal, newborn, and child health, non communicable diseases, and health sector support – is likely to magnify the competition for limited resources and exacerbate the effects of any downturn in development assistance for health.

“More than 300,000 mothers still die every year, and more than 7 million children die before the age of 5. Chronic diseases need more attention, and countries need better health care infrastructure,” Dr. Murray said. “All of these pressing health issues require funding, and it is becoming increasingly difficult to balance competing needs.”
Whatever the compulsions of funding agencies/beneficiary governments be, Dr Murray believes that 'when a program is started it should include an evaluation component so that everyone will have a detailed understanding of whether the program is improving health. This is gives developing country governments guidelines for how to best target their limited resources, which is actually the most important factor in health spending. Spending by governments on their own health programs on the whole far outweighs spending by donors.'


Shobha Shukla - CNS
(The author is the Editor of Citizen News Service (CNS) and also serves as the Director of CNS Diabetes Media Initiative (CNS-DMI). She has worked earlier with State Planning Institute, UP.  Email: shobha@citizen-news.org, website: www.citizen-news.org)  


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Thailand Shares Successful Experiences on Universal Health Coverage

Dr. Viroj Tangcharoensathien, the Director of International Health Policy Program, MOPH Thailand and the winner of Edwin Chardwick Medal Award, shared the successful experiences of Thailand over 27 years to achieve full Universal Health Coverage at the First Global Symposium on Health Systems Research (HSR), 16 – 19 November 2010, Montreux, Switzerland. Read more.

“By 2002 Thailand achieved full population coverage, which helps people to be able to access health services without pushing them to poverty because Thai government subsidized payments. Today all 650 districts were covered by a district hospital.” Dr.Viroj announced.

The key factors which helped Thailand to contribute to universal coverage includes political decision making and leadership, extensive trust base networks, policy networks, research networks and linkages among them.

Government effectiveness in its capacity to translate policy intention into actual implementation also contributed to success. In addition, Civil society involvement which included agenda setting on various policies: ART, renal replacement therapy for example. Health Service platform is vital otherwise Universal Coverage is a ‘citizen right in paper’ and Knowledge management: application of tacit knowledge, Health Systems Research also contribute to the achievement of universal coverage.

Thailand initially offered a favorable health package to low income group of 30 THB (US$ 0.7) and later on patients were not asked to pay anything. The Thai government contracted service providers and paid a certain amount to cover a certain number of people per year, instead of free choice fee for services reimbursement model.

Thailand still faces some serious challenges and these include:

  1. How to sustain efficiency, equity and quality achievement while strengthen capacity to address new challenges through evidence.
  2. And the demand for research outpaces the capacity in generating evidence.
  3. Also demographic and epidemiological transition for example Chronic long term care versus hospital acute care, effective coverage of interventions and primary prevention of risk factors.
  4. Non-health sector actions against determinants of ill-health such as Tobacco, alcohol, transfat, obesity, physical inactivity, safe environment and injury prevention.
  5. Institutional capacity to generate evidence on ICER, fiscal impact, equity and ethical considerations of new medicines, interventions.
“We have to maintain a sustainable model and continue to develop our research,” Said Dr.Viroj.

“We have to prepare the longer term care and ensure that our aging people are healthy and it would be better to encourage them to stay at home with family instead of in the health care centre and links between home care and the health sectors need to be established,” he said.

“Due to the increasing of cost related to health issues we should formulate policy which is related to long term care. On the benefit package we need to improve and strengthen of new intervention and new medicine.” he added.




Jittima Jantanamalaka - CNS
(The author is the Managing Director of Jay Inspire Co. Ltd (JICL), produces radio programmes in northern Thailand and writes for Citizen News Service (CNS). She is also the Director of CNS Diabetes Media Initiative (CNS-DMI) in Thailand. Website: www.jay-inspire.com, Email: jittima@citizen-news.org) 


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Monday, November 29, 2010

Book and video tell stories of TB in Thailand


Inspiring stories, both on paper and film, have recently been published to address the issue of tuberculosis (TB) in Thailand. The TB/HIV Research Foundation bundled the memories of volunteers working with people affected by TB in a book, and made a video to enhance treatment adherence among people living with TB. Read more.

In ‘Let me wipe your tears and touch your heart’ eight volunteers share their best practices and most inspiring experiences in caring for people with TB or with TB/HIV co-infection. These volunteers help people living with TB in coping with not only the physical suffering, but also the social, economic and psychological difficulties they face because of the disease. Many persons with TB and TB/HIV co-infection face depression, hopelessness, stigma and anxieties because of their disease.

In short chapters, the book reveals touching stories of the work of the volunteers, who themselves all had or are still living with TB, HIV or TB/HIV co-infection too. “It shows the important role of their volunteer work,” Saiyud Moolphate, project manager of the TB/HIV Research Foundation, at the 41st Union World Conference on Lung Health in Berlin, Germany (Nov 11-15).

“These volunteers might be poor in real life, but they are incredibly rich in their hearts,” she added. “They inspired many of the people who they took care of to become volunteers themselves too.” The book, published in both Thai and English, will be distributed at hospitals for free to ‘let people appreciated the volunteers’ work’.

The TB/HIV Research Foundation also released a new video for people with TB or TB/HIV and their family members. The twenty-eight minutes video focuses on increasing knowledge about TB, empowering people with TB and TB/HIV with the stories of survivors of the diseases, and building hope and will-power through messages from representatives of various religions.

By providing information and inspiration, the video aims to enhance treatment adherence.
Treatment of TB usually takes 6 to 9 months and many people find it hard to stick to the treatment. “Often people have to stay in an isolation room for some time. Depending on the situation this can vary from a few days to several weeks,” Moolphate explains in an interview with CNS. “There they stay alone, separated from everybody and everything. The video can help to give them power and hope to deal with the disease.”

Both the book and the video were produced in cooperation with The Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association (RIT/JATA) and sponsored by The Mitsubishi Foundation. Previously, the TB/HIV Research Foundation published similar books, such as one with the same title as the new video, in which stories and pictures of people with TB before and after treatment are printed.

Thailand is among the countries with the highest burden of TB in the world. According to recently released new data of the World Health Organization (WHO) there were around 130,000 TB cases and 12,000 TB deaths in Thailand in 2009.

Babs Verblackt - CNS
(The author is a freelance journalist, a Fellow of CNS Writers' Bureau and Associate Communications atTuBerculosis Vaccine Initiative – TBVI)

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Saturday, November 27, 2010

New Science, New Hope: Microbicides and HIV prevention

At the forthcoming Biennial Conference of the Irish Forum for Global Health (IFGH) in Maynooth, Ireland, one of the two keynote guest lectures - The John Kevany Memorial lecture - will be delivered by Dr Zeda Rosenberg, Chief Executive Officer (CEO) of the International Partnership for Microbicides (IPM) on "New Science, New Hope: Giving Women Power over HIV/AIDS." The microbicides refer to a new type of product being developed that people could use vaginally or rectally to protect themselves from HIV and possibly other sexually transmitted infections. Read more

One of the defining moments in microbicides advocacy was in July 2010 at the XVIII International AIDS Conference (IAC) in Vienna, Austria where successful results of the much awaited tenofovir microbicides clinical trials (CAPRISA 004) were announced: women who used the tenofovir microbicide gel were far less likely to become infected with HIV than women using a placebo gel. The tenofovir microbicide gel users were 39 percent less likely, overall, to become infected with HIV than women who received a placebo gel. More importantly, underlining the significance of adherence and counselling in clinical trials, women who used the tenofovir microbicide gel correctly more than 80 percent of the time, HIV infection was 54 percent less likely. Also as many advocates of new HIV prevention technologies demand – these tenofovir microbicide also showed activity against genital herpes (a sexually transmitted infection), reducing its incidence by half.

Let me put a word of caution here: this is undoubtedly welcome news, but research is not over yet. There is still a long way to go which may span over years through rigorous path of clinical trials and product development, before any microbicide can truly be available to communities.

One of the big debates around using anti-retroviral (ARV) based microbicides to prevent HIV transmission is that tenofovir is also used by people living with HIV (PLHIV) for their ARV therapy. PLHIV take oral version of tenofovir in ARVs like Viread, Truvada and Atripla.

So the worry is: will using this ARV based microbicide (tenofovir in this case) make people resistant to tenofovir and thereby negate the positive outcomes of ARV based therapy later in their lives in case they become infected with HIV and require the ARV treatment?

"There is now evidence to indicate that ARVs can prevent HIV as well as some of the non-HIV STIs. The major challenge facing the Microbicides Society of India (MSI) as well as other partner research agencies globally, would be to make  a combination of different ARVs, so that these products  become more effective, safer and user friendly for preventing the HIV and some of the non-HIV STIs as well as reproductive tract infections (RTIs). It would be an icing on the cake, if few of these microbicidal products could also provide the contraceptive protection concurrently to the users of these products" said Dr Badri N Saxena, President, Microbicides Society of India (MSI), who is a globally acclaimed researcher and an inspiring advocate for new HIV and reproductive health technologies.

"One reason for engaging ARV drugs into microbicides development is to accelerate the candidates that are ready to go into clinical trials because they come from a very rich product development profile. So now we have so many good candidates, can we provide the much needed bridge to establish biological plausibility - to find out will these things actually work in clinical trials" said Prof Robin Shattock to this correspondent at the International Microbicides Conference in Pittsburgh, USA (May 2010).

Also at the International Microbicides Conference earlier this year, two key studies were presented - one study involving a mathematical model and the other assays of cells and tissue, and both these studies arrived at the same answer to the worrying question whether drug resistance could be a problem if ARV drugs become a mainstay for HIV prevention. Resistance could happen, if people, who are unknowingly already infected with HIV, use the approach. So in other words, if HIV negative people use ARV based microbicides the risk of developing resistance is not there, but if they are already HIV positive and unaware of their status, the risk of resistance is there. These two studies underscore the importance of incorporating routine HIV testing and ongoing monitoring of infection status in any prevention program that involves the use of ARVs.

Probably the forthcoming Irish Forum for Global Health (IFGH) biennial conference might offer some answers to these concerns and give a major thrust to research and eventual development of new HIV prevention technologies. We will post the audio recording of Dr Zeda Rosenberg's lecture at Irish Forum for Global Health (IFGH) biennial conference on www.citizen-news.org! Stay tuned!

Bobby Ramakant - CNS 

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Friday, November 26, 2010

Right To Sight (RTS) committed to eliminate avoidable blindness

Three-quarters of all blindness can be prevented or treated. Avoidable blindness poses an enormous challenge to healthcare system, particularly in low- and middle- income countries. There are nine million people in Africa alone with preventable blindness, out of which 50-75% people are blind due to cataract and 5% due to glaucoma, says Keerti Bhusan Pradhan (Right To Sight) who is heading to Ireland to present his work in Africa at the Irish Forum for Global Health (IFGH) biennial conference next week (29-30 November 2010). Read more

Although blindness in 50-75% people is attributed to cataract, the health response has been appalling. According to the World Health Organization (WHO), cataract surgery is one of the most cost-effective treatments that can be offered in developing countries. It can allow people to increase their economic productivity by up to 1500% of the cost of the surgery during the first post-operative year.

According to WHO, about 314 million people are visually impaired worldwide, 45 million of them are blind. Most people with visual impairment are older, and females are more at risk at every age, in every part of the world. About 87% of the world's visually impaired live in developing countries.

The leading causes of chronic blindness include cataract, glaucoma, age-related macular degeneration, corneal opacities, diabetic retinopathy, trachoma, and eye conditions in children (including those caused by vitamin A deficiency). Age-related blindness is increasing throughout the world, as is blindness due to uncontrolled diabetes. Three-quarters of all blindness can be prevented or treated.

Keerti represents the Right To Sight (RTS) which is dedicated to eradicate preventable blindness through the use of proven techniques in cost recovery, training and surgical practice. One of the major landmarks of Keerti is his contribution to improving eye care and preventing avoidable blindness in India as well as many countries in Africa.

Investing in preventing avoidable blindness is not only a public health imperative but also a smart investment as it saves costs for countries and donors, says Keerti. According to a research done by Frick and Foster, the estimated cost of global blindness and low vision was USD 42 billion in 2000. Without a decrease in the prevalence of blindness and low vision, it was projected that the total annual costs would rise to USD 110 billion by 2020. However, if avoidable blindness is eliminated, this projected cost will be reduced to only USD 57 billion in 2020, says Keerti.

There are many challenges to initiatives that aim to eliminate avoidable blindness and two major ones are inconsistent quality of care and shortage of healthcare workers in Africa, says Keerti.

One of the novel approaches Right To Sight brings in is using private public partnership (PPP) to engage private sector in public health. Most of the healthcare in sub-Saharan Africa is in public sector and Keerti envisions a growing role of private sector in meeting public health needs in the region. According to a research study, USD 20 billion of additional investment is needed for healthcare in private sector to improve health outcomes in Africa.

Keerti believes that operational ownership of eye hospitals by the private sector partners is vital. Right To Sight, a non-profit, works in partnership with Shalina Laboratories which is a pharmaceutical company in Democratic Republic of Congo (DRC). Shalina plans to expand Right To Sight's PPP model of eye care delivery to 18 African countries with six centres planned in DRC in phases.

This pilot would provide road map for many private partnerships to have eye care services in Africa leading towards the goal of eliminating avoidable blindness by 2020 says Keerti.

Preventing avoidable blindness mandates a stronger response at all levels and from all stakeholders. Let's hope that the forthcoming biennial conference of Irish Forum for Global Health (IFGH) next week will be a game changer for evoking the warranted response to eliminate avoidable blindness.

Bobby Ramakant - CNS 

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An Integrated Health System Is What We Need

Health remains the most important goal in one’s life. All diseases need proper attention, though (one may argue) some need more attention than others. Our fight should not be directed merely against certain specific diseases, but to have  a disease free and healthy mind and body. To achieve this, we will need to strengthen health systems and work towards the fair and equitable distribution of health care resources to all those who need them. Read more

Many developing countries have extremely weak public health systems. About 80% of India’s health care delivery system is through the private sector. This makes it even more complex to deal with it, because the role of primary health centres in community health is very crucial – whether we are dealing with non communicable diseases (NCDs) or communicable diseases (CDs).

The last few years have seen a tremendous increase in funding for some diseases like HIV/AIDS in comparison to the so called non sexy illnesses like tuberculosis, diabetes and acute respiratory infections (ARIs). According to the first ever Acute Respiratory Infections Atlas published very recently, ARIs are the third largest cause of mortality in the world and take twice the toll in lives lost, as compared to HIV. Still only about 1% ($32 million) of all pharmaceutical research/development funding was spent on research for ARIs in 2007 as compared to $1.1 billion spent on HIV related research. According to Peter Baldini, CEO, World Lung Foundation, "We know that at least four million people die from ARIs, yet the global health community does not even recognize them as a distinct disease group."

So despite being major killers, some diseases may receive a fraction of government and donor agency support, for various inexplicable reasons. This disproportionate funding should be viewed as a positive problem, according to Dr Anil Kapur, President, World Diabetes Foundation (WDF).

He says that "The past 20 years have witnessed a tremendous amount of health development systems emerging and we must compliment the world community to have come together to provide that sort of assistance. It started with the activism of HIV/AIDS, justifiably at the point of time where people felt the need of help, which was provided. We have thus built some systems to deal with the issue. Over a period of time we are learning that some actions we took to deal with different health problems (like HIV/TB, malaria, etc) might not have been appropriate. The debate about disproportionate funding in some health sectors has started to happen. I am positive that there will be more equity in the distribution of resources. The clear issue is that if money goes not only to provide drug treatment, but to improve health systems, then we can surely reap better benefits. Funding should be for health and local governments should be allowed to allocate funds according to specific needs."

It indeed is an artificial way of looking at health issues by compartmentalizing communicable and non communicable diseases. Dr Kapur rightly believes that the same public health principles apply to both. For example, if an index case of a communicable disease like tuberculosis is identified, we try to provide a protective environment, where people surrounding this person are tested so that infection does not spread. In diabetes too, when an index case is identified, the family members should be given appropriate advice as they share the same risk behaviour as the index case. Another example is the issue of HIV/AIDS. When patients are given anti retro viral treatment (ART), many of them may develop metabolic syndrome, over a period of time as part of side effects of the drugs. Should they not be treated for diabetes, which they develop as a side effect?

A mother on ART to prevent mother to child transmission, may develop gestational diabetes. And then we will not be able to separate the two issues. To me linking maternal health and prevention of future diabetes is a very relevant issue.

The whole field of foetal origins of adult diseases has come to the forefront as the first 1000 days of life since conception are very crucial in determining our future health. If a mother is undernourished, she will give birth to a small weight gestational baby. If this happens to be a girl child, she might develop gestational diabetes and/or other diseases later, and pass the risks to her offspring.

Hence maternal and child health forms the backbone of all health care systems. We need to integrate all these critical public health issues at the primary care level. TB, HIV/AIDS, diabetes are all becoming chronic diseases, and should not be compartmentalized. Dr Kapur feels that we should talk to each other and do not compartmentalize. It is time that organizations, agencies, and specialists reach out to each other and understand the problems of health care delivery. Then we can resolve the issue of equity and imbalance in resources.

We need to build public health systems where we are able to provide knowledge and information about relevant illnesses, in a given community, and use that to provide them basic curative services. This is the real challenge.


Shobha Shukla - CNS
(The author is the Editor of Citizen News Service (CNS) and also serves as the Director of CNS Diabetes Media Initiative (CNS-DMI). She has worked earlier with State Planning Institute, UP. She was supported by the Stop TB Partnership to write from the 41st Union World Conference on Lung Health, Berlin, Germany (11-15 November 2010). Email: shobha@citizen-news.org, website: www.citizen-news.org) 




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Thursday, November 25, 2010

Will access to essential asthma medicines be on NCD Summit agenda?

Asthma is the most common chronic disease. Since 2000, some areas of public health, such as tuberculosis (TB), have gone from being deprived of resources for decades to having significant amounts of funding. While important gaps remain, this “dream come true” has also revealed that spending better is equally necessary as spending more. Ms Cécile Macé, Pharmacist and Coordinator, The Union's Asthma Drug Facility (ADF) said at the 41st Union World Conference on Lung Health in Berlin, Germany that "ADF improves affordability of essential asthma medicines in developing countries." Read more

It is not only important for the countries, particularly low- and middle- income countries to have access to affordable asthma medicines but quality is important to monitor as well. The Asthma Drug Facility (ADF) is a mechanism to improve access to affordable and quality asthma medicines where they are needed most, said Cécile Macé.

Lack of adequate skilled healthcare providers to manage asthma care is also a critical impediment to the response. Improving skills of healthcare personnel by the development of guidelines and training packages, is another key priority to improve response to asthma in low- and middle- income countries, said Cécile Macé.

Assessing quality of asthma care by regular monitoring, is another key challenge, said Cécile Macé.

Policy makers and economists need to understand that asthma care is a smart investment –because costs increase manifold when asthma is either not treated at all or incorrectly treated. So a wise strategy and to make the best use of every resource available, it is vital to manage asthma in the right way and provide standard treatment and care, said Cécile Macé. We need to reduce the unnecessary expense of emergency asthma, said Cécile Macé.

Due to sustained advocacy, one of the outcomes is that there is more financial support available for asthma programmes. Around 30 countries received funds through the Global Fund to fight AIDS, TB and Malaria (GFATM) under their tuberculosis (TB) application to implement the Practical Approach to Lung health (PAL) strategy, which is a part of the WHO Stop TB Strategy, which also includes among others, an asthma care component. Other health financing mechanisms need to consider supporting asthma care as well.

One of the methods for financing medicines is a revolving drug fund (RDF) in which after an initial capital investment, medicine supplies are replenished with monies collected from the sales of medicines. We should encourage donors to support the purchase of asthma medicines through initiatives like Revolving Funds. Revolving fund is a sustainable solution for asthma response, said Cécile Macé.

It will be strategic opportunity for the forthcoming United Nations (UN) Summit on non-communicable diseases (UN Summit on NCDs) in September 2011 to also address this need to ensure access to essential asthma medicines in low- and middle- income countries.

Bobby Ramakant - CNS 


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More poverty and tuberculosis (TB) in indigenous peoples

"Where we have indigenous people, we have more poverty and more TB incidence" said Mirtha del Granado, Regional Adviser on TB, WHO (in Americas) at the 41st Union World Conference on Lung Health, Berlin, Germany. There are 63,432 missed cases of TB in Americas (North, Central and South America), said Mirtha. Most of them are in Priority countries detecting less than 50% TB, said Mirtha. Read more


According to estimates about 6% of the population in Americas (45-50 million) are from indigenous communities, which include 400 different indigenous populations living in 24 countries.

Stressing on the link of poverty with TB, Mirtha said that 94% of indigenous population in Latin America are living n TB priority countries. In priority countries like Guatemala and Peru, more than 40% of their population is indigenous.

In Chile, the TB incidence in general population is 25 cases per 100,000, but among indigenous communities in Peru, the TB incidence is of 170 – about 6 times more!

In Brazil, TB incidence in general population is 20 per 100,000 but among indigenous communities it is 32.7

In Panama, TB incidence in general population is 43 per 100,000, but among indigenous communities it is about 126-167.

In Mexico, TB incidence in general population is 27 per 100,000, but among indigenous communities it is about 236 – close to nine times more!

In Canada, TB incidence in general population is 5 per 100,000, but among indigenous communities it is about 24.5 – about five times more!

Brazil is a good example of addressing TB in indigenous population effectively. There is a special national policy to offer integrated approach to indigenous populations in Brazil.

As a result of sustained efforts to address TB in indigenous communities in Brazil, the TB rate has come down among indigenous peoples from 97.2 (2001) to 32.7 (2008). In general population the TB rate in 2008 was 20.65 per 100,000.

The declining incidence of TB in indigenous populations in Brazil is an outcome of a combination of TB programme and development programme said Mirtha.

Bobby Ramakant - CNS 


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Right to health of indigenous peoples essential to Stop TB

"Basic human rights as enjoyed by others have not benefitted indigenous peoples. Therefore the respect and recognition of the rights of indigenous peoples is critical to our dignity and survival. In particular, implementation of our right to health is essential if we are to stop TB" said Wilton Littlechild, Regional Chief, Assembly of First Nations, who was speaking at the 41st Union World Conference on Lung Health in Berlin, Germany. Read more

There are approximately 370 million indigenous peoples globally in more than 70 countries. Although programmes have been designed to combat TB, indigenous populations globally have been left out of such efforts due to cultural barriers, language differences, geographic remoteness, and economic disadvantage. TB rates among indigenous people are consistently higher than general public. During the five year period 2002-2006, the first nations TB rate was 29 times higher than others born in Canada - for the Inuit, it was 90 times higher. Pacific islanders and Maoris are 10 times more likely to contract TB than other people living in New Zealand. In Kalaallit Nunaat, Greenland, residents have a risk rate more than 45 times greater than Danish born citizens. More than 80% population in Greenland is indigenous.

These challenges will not be easily met - but they can be met by ensuring indigenous peoples are true partners in global TB control. We have a comprehensive and achievable plan to stop indigenous TB globally, but to realize our goal we need support, said Chief Littlechild.

Indigenous people have a consistent pattern of health inequality across a variety of jurisdictions from resource poor to the resource rich. Indigenous health inequalities are multi-faceted, and are both social and political in nature.

The inequities faced by indigenous peoples are much severe than in general population. Countries like Canada report that poverty has gone down but poverty in indigenous peoples has gone up. In prisons too there are a significant number of indigenous peoples. There are host of other life conditions that put these people at an elevated risk of infectious diseases like TB - overcrowded housing and lack of access to safe drinking water are just few of those challenges.

The strategic framework to control TB among indigenous peoples was developed through consultations with indigenous leaders, TB experts and health advocates from over 60 countries. It is designed to take an indigenous approach that links the right to health, education, housing, employment, and dignity. It is based on equality of opportunity to the highest level of health attainable world wide. It will serve as a tool to build a social movement to raise awareness of indigenous TB, to develop targets and messages, to pilot interventions and to monitor TB trends among indigenous peoples. An important component to this framework calls upon indigenous peoples to demand access to TB prevention and treatment measures in their communities.

Bobby Ramakant – CNS 


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Canada endorses the Declaration on Right of Indigenous Communities

As the 41st Union World Conference on Lung Health in Berlin, Germany was going on, another development took place in Canada – which will surely impact public health including tuberculosis (TB) and lung health among indigenous communities. Canada endorsed the Declaration on the Rights of Indigenous Communities. Wilton Littlechild, Regional Chief, Assembly of First Nations, has been a powerful advocate demanding this endorsement from Canada since years. Four states had voted against the declaration initially, New Zealand, Australia, United States of America and Canada. However, New Zealand and Australia had changed their position and endorsed the declaration earlier. Now Canada too have endorsed the declaration, thankfully. Read more


"Indigenous people around the world have sought recognition of their identities, their ways of life and their right to traditional lands, territories and natural resources. However throughout history, their rights have been violated" said Chief Littlechild.

Chief Littlechild gave an overview of significant milestones in demanding policy change and responses to the human rights of indigenous communities.

In 1923, Haudenosaunee Chief Deskaheh had travelled to Geneva to speak to the League of Nations and defend the right of his people.

1925 Ratana first travelled to London with a large delegation to petition King George, but he was denied access.

The International Labour Organization (ILO) Convention 169 (1991) Article 3 states that indigenous peoples must fully enjoy fundamental human rights without obstacles or discrimination.

The ILO Convention 169 Article 2 gives governments the responsibility for ensuring that all indigenous people have the same rights and opportunities as non indigenous peoples.

The ILO Convention 169 Article 5 recognizes and protects the social, cultural, religious and spiritual values and practices of these peoples.

The ILO Convention 169 Article 7 specifically refers to the obligation that states parties have with regard to the improvement of the conditions of life work, levels of health and education as a matter of priority in national plans.

The ILO Convention 169 Articles 14 and 16 guarantee the rights of ownership and possession of land by indigenous peoples and the right not to be displaced.

"No health without land for indigenous people," rightly said Chief Littlechild.

"The declaration on the rights of indigenous people was adopted by the general assembly on 13 September 2007. The declaration is the most comprehensive statement of the rights of indigenous peoples ever developed, giving prominence to collective rights to a degree unprecedented in international human rights law" said Chief Littlechild.

The drafting of the declaration began in 1985 and the first draft was completed in 1993. In 1995, the commission on human rights set up its own working group to review the draft adopted by the human rights experts of the working group and the sub-commission, said Chief Littlechild.

"There are many steps that should be taken to apply indigenous rights’ lens to TB programmes" said Chief Littlechild.

Countries like Bolivia, Colombia, Ecuador, and Mexico, have all written multiculturalism into their constitutions to ensure that their country’s legislation conforms with convention obligations and international human rights guidelines related to the highest attainable standard of health.

"The ministers of health and policymakers should be trained on the obligations from international human rights conventions to which their government is a party. If national health policies, plans, and programmes, do not align with these obligations, efforts should be undertaken to revise them so as to make them consistent with those conventions and standards" said Chief Littlechild.

Policy makers can build and expand databases from national and sub-national sources to measure and monitor the impact of ethnicity on the exercise of human rights and fundamental freedoms related with health and the right to health per se, said Chief Littlechild.

The national TB control programmes (NTPs) can systematically monitor TB trends among indigenous populations to determine ways to improve healthcare. NTPs can also investigate the ways in which health is determined by outside factors, and the extent to which the government can remedy problems of infrastructure, said Chief Littlechild.

The NTPs, NGOs and civil society should also build networks of national and sub-natoinal research institutions that focus on health or other issues of importance to indigenous populations.

The minister of health can encourage the dissemination of culturally appropriate health information materials in local languages, the inclusion of traditional leaders, healers in health promotion, said Chief Littlechild.

Outlining the unique social determinants that affect health of indigenous communities, he listed: colonization and colonialism, residential schools in some schools TB rates were so high that they were locally referred to as TB schools), language and culture, indigeneity, geographical locale, racism and self determination.

Victoria Tauli-Corpuz, Chairperson, of Permanent Forum on Indigenous Issues, had once said: "Actions taken to reach the MDG [millennium development goals] health goals cannot be measured solely in terms of improving average health outcomes. They must also be evaluated in terms of their consistency with a human rights based approach which emphasizes participatory, non-discriminatory and accountable actions to improve the health of indigenous peoples."

Endorsing of the declaration on rights of indigenous communities by Canada and other nations shall go a long way in not only reducing diseases like TB among indigenous peoples but also improving quality of life and conditions that respect human rights.

Bobby Ramakant - CNS  


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Irish Forum for Global Health calls for protecting health aid funding

"Current economic crisis threatens to reverse much of the progress made in developing countries"
The Irish Forum for Global Health (IFGH) is concerned at the further cuts to the overseas aid budget in the Government's four-year plan. It urges the Government to protect aid funding for health and HIV programmes in developing countries and to keep its promise to increase aid to 0.7% of Gross National Income (GNI) by 2015. The current economic crisis threatens to reverse much of the progress made in developing countries over recent decades and UNESCO estimates that the economic downturn will cause between 200,000 and 400,000 additional child deaths each year between now and 2015. Urgent measures are needed to protect the poor and vulnerable. Read more


Ireland has a responsibility to help address the health needs of developing countries. While health in Ireland has steadily improved, the gap has widened between Ireland and the least developed countries.
External aid for health has proven to be effective. For example, more than 5 million people are now on anti-retroviral treatment for HIV in developing countries, compared to just 300 thousand in 2002. There has been a dramatic reduction in malaria deaths due to the distribution of insecticide-treated bed nets. Aid for health has also been good for economic development as tackling major diseases such as tuberculosis (TB) and malaria makes people healthier and more productive.

Developing countries are dependent on external aid to provide even the most basic healthcare. Cuts in aid budgets make it harder for governments to invest in critical service developments, such as recruiting new health workers, provision of emergency obstetric care and safe delivery services, and expanding immunisation programmes. Some of these effects will reverse hard-fought gains and have long term consequences for health in these countries.

Ireland's aid budget was reduced from €920 million in 2008 to €722 million in 2009. European Commission President José Manuel Barroso has said "The recession must not, cannot, will not be used as an excuse for going back on aid promises." Other European countries, including the UK, have managed to maintain aid levels despite recession.

Ahead of his Keynote Speech to be delivered at the Irish Forum for Global Health Biennial Conference 2010 taking place at the end of November, Professor Father Michael Kelly, well known and respected Irish Jesuit priest, researcher and author who has lived in Zambia for over 50 years gave his view on Irish foreign aid for health "Maintaining levels of aid, especially for health, makes economic sense, is the right, just and decent thing to do, and is something that even in the current difficult economic climate the majority of Irish people would want. Reducing the level of aid would bring only minor relief to the Irish budget but would mean major budgetary and human setbacks in recipient countries."

Dr David Weakliam, of the Irish Forum for Global Health (IFGH), stated: "Health is a vital part of the Government's overseas development programme. The further cuts in aid in the four-year plan will undoubtedly have a negative impact on the health of people in the poorest countries. They will also damage the excellent reputation Ireland has earned for its assistance to the underprivileged in developing countries."

The Irish Forum for Global Health (IFGH) opposes further cuts in the aid budget in order to protect the health of the world's poorest and most vulnerable people.

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Wednesday, November 24, 2010

Diseases of poverty to be in spotlight at IFGH biennial conference

The biennial conference of the Irish Forum for Global Health (IFGH) to mark the World AIDS Day (1 December) is focussing on the theme of "Partnerships to address health and diseases of poverty challenges." IFGH together with National University of Ireland (NUI) Maynooth and Irish Aid is organizing this two days meet (29-30 November 2010) bringing together experts from all sectors involved and working on global health - in particular, issues affecting the developing world. Read more

The media advisory issued by IFGH says: "The conference will provide an unusual combination of science, research and hands-on projects being implemented by NGOs."

This biennial conference will feature over 50 presentations on a range of issues related to health - from HIV to malaria, from eye health to climate change, from nutrition to health service provision.

The two major highlights of this conference are the coveted lectures: John Kevany Memorial Lecture and 2010 Father Michael Kelly Lecture.

The John Kevany Memorial lecture will be delivered by Dr Zeda Rosenberg, Chief Executive Officer (CEO) of the International Partnership for Microbicides (IPM) and she will speak on "New Science, New Hope: Giving Women Power over HIV/AIDS."

The 2010 Father Michael Kelly Lecture for World AIDS Day will be delivered by Father Michael Kelly on "HIV and AIDS: Accomplishments and enduring challenges." He will be joined by James O'Connor, HIV activist and development manager of Open Heart House, Dublin who will speak on "HIV and AIDS - A positive perspective." James O'Connor is acutely aware of the human cost of living with HIV and AIDS due to his personal experience of AIDS. He is one of the founding HIV positive members of Open Heart House, says the IFGH media advisory.

A new book written by Father Michael Kelly will also be released at this biennial conference, titled "HIV and AIDS: A social justice perspective."

For more information on the IFGH biennial conference, click here 

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