Archive for January 2008
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
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.
(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.
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
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  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. Read the rest of this entry »
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.