13 Cents a Month for BOP Health Insurance

A C.K. Prahalad speech was recently profiled by a Wharton newsletter, in that lecture he spoke about Indian farmers paying 13 cents a month for health insurance which allowed:

Narayana Hrudayalaya, a pediatric heart hospital in Bangalore, to operate upon 25,000 farmers and to offer free medical consultation to 85,000 more. “This year we have increased the monthly contribution by farmers to Rs 10 (25 cents) a month, but still, we hope to cover 13 million individuals using the world’s largest telemedicine network to deliver critical health services to rural areas…

This displays the power of pooled community based insurance. The first thing that came to my mind is that this has a shot of working because India is a place with massive volume, human resources and technological capacity. These are sweeping generalizations, but they are worthing thinking about when comparing India to other developing regions that do not have the same capacity on these three fronts. Never-the-less this is a great example and experiment that may hold powerful lessons.

 ‘The Poor Deserve World-Class Products and Services’
Published: January 24, 2008 in India Knowledge@Wharton

Life insurance for HIV+ in South Africa

I belatedly discovered podcasts in my final weeks in Mbarara (Uganda) last December.  Two series, PRI radio programs on Health and Technology, have short stories that may interest readers.  The Health coverage includes a subset of HIV-specific podcasts.

One story from March 2007 reported on the new life insurance market for HIV+ residents in South Africa signaling a dramatic shift in access to HIV treatment. Interestingly, life insurance can be one requirement for securing a home mortgage.  According to the report, until recently without a life insurance policy, even well-off HIV+ individuals would have had a more difficult time trying to buy a home.

WHO Launches Tracking System for H5N1 Viruses

(Summary of ProMedMail Report of 24 January 2008)

Responding to concerns raised by Indonesia and other developing countries, the WHO has instituted an electronic tracking system to track H5N1 isolates submitted, and what is done with them. Vietnam and Indonesia have provided the most isolates, but are concerned that private companies that are developing vaccines from these isolates will market vaccines that are too expensive for developing countries to purchase in the event of an outbreak. In 2007, as a result of these concerns, Indonesia withheld samples for 5 months.

A country-by-country list of submissions has been created, and the tracking system permits anyone to search for particular isolates by date of submission, source country, host species, and several other variables. The system provides a page of detailed information for each isolate, including a list of all the laboratories to which the virus has been distributed, including pharmaceutical companies.

Experts Call for Rethinking AIDS Money

This week’s KaiserNetwork report just hit the two hottest topics for me on HIV right now: male circumcision (Rwanda now has a formal program) and the flattening of vertical HIV funds into primary care, 30 years after the Alma Atta conference had called for a universal primary care package.

“In the two decades since AIDS began sweeping the globe, it has often been labeled as the biggest threat to international health. But with revised numbers downsizing the pandemic — along with an admission that AIDS peaked in the late 1990s — some AIDS experts are now wondering if it might be wise to shift some of the billions of dollars of AIDS money to basic health problems like clean water, family planning or diarrhea.”

“If we look at the data objectively, we are spending too much on AIDS,” said Dr. Malcolm Potts, an AIDS expert at the University of California, Berkeley, who once worked with prostitutes on the front lines of the epidemic in Ghana.

Read the full story at the KFF.

P.S. The CGD blog (Is donor spending on AIDS a “Gross Misallocation of Resources”?) highlights findings from a recent paper on global health funding for HIV, population, infectious disease control, and broad health sector support. Two key points:

• donor support for AIDS has grown from around 5% of total health commitments in 1992-3 to about 30% in 2003-5, a six-fold increase of AIDS’ share, but
• funding for general health sector support is the fastest rising category in absolute terms in the years 2003-5

Setting the Global Health Research Agenda – Bamako 2008

Here’s your opportunity to influence the global health research agenda: the WHO is asking for global input on their agenda for the 2008 Global Ministerial Forum on Research for Health via meetings with stakeholders, an on-line consultative questionnaire, and will be holding a structured e-forum in Spring 2008 to discuss the agenda. The call for conference papers will be sent out in February 2008, and the Lancet will publish an issue on global health to complement the conference – article submissions for inclusion are due in June 2008. The conference will be held in Bamako, Mali from 17-19 November 2008.

PURPOSE AND MEETING IMPACT
“From Mexico to Mali: a new course for global health” in the 12 January 2008 Lancet spotlights the planning process and expected impact of this meeting. The first meeting was convened in 2004 in Mexico City, and according to Lancet’s article:

“Ministers attending the [2004] summit committed to three key priorities: health-systems research, securing public confidence in research, and bridging the gap between knowledge and action.

 

These developments might have helped to stimulate the recent explosion of innovative new ideas and initiatives in global health. First, some innovative developing countries (IDCs) such as Brazil, China, India, and South Africa have become important producers of low-cost drugs and vaccines. Second, donors and developing countries have both begun, rightly, to embrace science and technology as key drivers of social and economic development.

First year improvements in Uganda OBA clinic utilization and claims quality

This piece is cross-posted from the Uganda output-based aid (OBA) site which just got a major under-the-hood overhaul in its move to a blog format. The Uganda OBA project contracts private clinics to see qualified patients for complaints of suspected sexually transmitted infections (STIs). Patients who buy a subsidized voucher from local drug shops and pharmacies are entitled to seek care for themselves and their partner at any of the contracted clinics. Clinics are reimbursed on a negotiated fee-for-service schedule.

The following report (“VSHD, 2007, Assessment of OBA Clinic Utilization”) is an evaluation of the OBA program’s first year impact on utilization at participating clinics (July 2006 to June 2007).  The study, led by Berkeley graduate students Richard Lowe and Ben Bellows, was undertaken June to August 2007 and required an extensive review of thousands of handwritten lab and outpatient entries at OBA facilities. Records were kept differently at many of the clinics and,at several clinics, data were simply not available. However, we have information from 7 of the 16 clinics and they indicate a strong patient uptake and program improvement in the first year of OBA. One of the more dramatic findings is that the total number of patient visits at contracted clinics increased 226% in the first year of OBA compared to the year before OBA.

It does not appear that patients who have attended OBA clinics simply substituted the OBA voucher for their own out-of-pocket spending. Taking all seven clinics together, the number of non-OBA patients seeking STI treatment actually increased in the first year of OBA. One likely reason is that social marketing stimulated greater demand for STI treatment beyond the voucher-using population.

Program adherence also appears to be improving over the first year of OBA as the number of fully paid claims increased from 30% of all submitted claims in July/August 2006 to 70% of all claims in June 2007. Although it should be stressed that claims quality varied significantly between providers.

There is some concern about the quality of lab testing at participating clinics. Lab technicians could benefit from better on-site follow-up and incentives for high quality diagnoses. However, the percent of positive gonorrhea tests more than doubled, indicating increased awareness of this infection in the community and at provider clinics.

The report paints a detailed picture of the participating clinics in their first year of OBA and it is hoped that findings can be used for program improvement as the expansion is planned.

Our many thanks go to both Microcare and MSI who graciously assisted with our many requests for supplemental data and assistance reaching clinic providers. Many thanks as well to the KfW Development Bank and the Bixby Program at UC Berkeley for funding the research.

Back in the Saddle – Happy New Year Link Drop

After a holiday hiatus I should be back to blogging much more frequently. I did some desk clearing from emails that had gathered over the past month and naturally many of them were year end Top 10 lists. I thought it would be appropriate to capture some of these below. In addition to starting off with a couple of miscellaneous links, I included a section on business and global health. Once again I do this because I strongly believe it is important to understand the impact the business community/private sector is having on the issues we care about. In my opinion folks in the public health world are almost completely incognizant of what is happening with respect to this (and to be fair the opposite is also true). Enjoy the links below, I probably will have some more desk clearing to do as the week goes on. In particular the first link under the business and global health section below on Melinda Gates is quite interesting if you care to know more about her.

Miscellaneous
Global Health Photo Contest, link
The Global Health Council’s Photography Contest is dedicated to drawing attention to health issues that have a global impact. Deadline is Feb 15, 2008.

What can $611 Billion buy? Try this – feeding the world’s poor for 7 years. Link
via Good Magazine.

Top 10 Lists
*Top 20 Global Health Priorities, link
In one of the world’s largest public-health collaborations, 155 experts from 50 countries have a plan to tackle the world’s deadliest diseases. The result is a list, published in the journal Nature, of the top 20 research and policy priorities in chronic non-communicable diseases – which account for 60% of all deaths worldwide. It’s “a road-map” for action, says lead researcher Abdallah Daar at the McLaughlin-Rotman Centre for Global Health in Toronto.

*A Year of Worldchanging Ideas, link
Exec editor Alex Steffen of Worldchanging has compiled their best of list in several categories. The full list is below, I have selected a few that I liked: “Over the last year we ran more than 2,000 stories, including a number of pieces that I think are pretty much the best stuff we’ve ever done… here is my list of the top Worldchanging posts of 2007. It’s very subjective, though many of these stories have also been among our most popular (judged by visits) and provocative (judged by media coverage and blog links) posts.

• Tools for Understanding Poverty, link

• The Open Architecture Network and the Future of Design, link

• Transforming Philanthropy, link

*10 Highly Consequential Implications of Climate Change, link
A new report called The Age of Consequences, forecasts climate change in the coming century. It makes for fascinating if frightening reading. See table for impact on global health. via.

*Top 7 Social Entrepreneurship Blogs via Riches for Good
Finding and funding sustainable, scalable solutions to end global poverty

*Top 10 Wins For Women’s Health in 2007, link
Women’s health was a priority concern in 2007, as global donors, international agencies, and influential private foundations realized that investing in women’s health is investing in the world (hat tip – Pump Handle).

*The Independent announces its top 6 social entrepreneurs, link
Last year, The Independent – in collaboration with The Schwab Foundation for Social Entrepreneurship and the Boston Consulting Group – began a quest to find the UK’s most successful social entrepreneurs. (hat tip)

*10 Videos to change how you view the world (all TED videos), link

*10 top global health issues according to WHO, link (via)

*10 Universities With the Best Free Online Courses, link (via)

Business and Development/Global Health

*Who is Melinda Gates?, link
Interesting read: “Years before Melinda French met and married Bill Gates, she had a love affair – with an Apple computer…Of all the tricks that life can play, it’s hard to imagine any stranger than what befell Melinda French. Today she is married to the richest man in America – and giving billions of dollars away…”

*Global pharma firms take a tropical dose, link
Multinationals focus on diseases in developing countries as they lose protection by patents at home. The big multinational drug makers are increasingly focusing their research on diseases that no longer afflict their home countries. As many as nine companies are developing medicine for tuberculosis, which claims two million lives every year. At least seven are focusing on malaria, another killer.

*IFC betting 1 Billion on Africa’s private sector to improve health, link
The IFC plans to set up an equity investment fund, ultimately worth up to $500m, including money from other donors, to invest in small and medium-sized enterprises in the health-care industry. It also wants to create a $400m-500m debt vehicle that will fund local banks that lend to such entrepreneurs. See also – http://www.ifc.org/HealthinAfrica

*On Malaria: Charity vs. Capitalism in Africa, link
Africa’s best hope to fight malaria is the wide distribution of mosquito-repelling bed nets. But who best serves that need: the public sector or private interests?

*2 Young Hedge-Fund Veterans Stir Up the World of Philanthropy, link
As hedge-fund analysts, Holden Karnofsky and Elie Hassenfeld made six-figure incomes deciding which companies to invest in. Now they are doing the same thing with charities…Their efforts are shaking up the field of philanthropy.

*Oprah effect brings microlending to Main Street, link
Kiva hit the publicity jackpot in September when Oprah Winfrey featured the organization on her daytime television program, attracting a tidal wave of interest from Middle America. Demand was so high the day the episode aired, every loan on the site was fulfilled.

*Heinz Pledges to Provide Free Micronutrient Assistance to 10 Million Children by 2010, link
The H. J. Heinz Company is working to develop solutions to reduce global malnutrition, a commitment underscored in the Company’s 2007 CSR report. The report lays out the Company’s plans to provide free micronutrient assistance to 10 million children at risk of iron-deficiency anemia by 2010.