Breaking News: Link 166

Breaking News Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

medusa

Breaking News: Link 166

 

Health at a Glance 2015 

WHO: public health round- up 

Gender, health and the Sustainable Development Goals 

Visualizing health progress and disparities in China  

Trade, Health, And Tobacco Exceptionalism: The TPP Tobacco Carve-Out 

European Parliament: It is not healthy: Mending the broken medicines innovation model December 2 @ 12:45 pm – 3:00 pm 

Medicines Patent Pool Expands To Include Hepatitis C, Tuberculosis 

Access: MSF launches global action against Pfizer and GlaxoSmithKline to cut the price of the pneumonia vaccine 

LDC Coordinator Thanks WTO For ‘Accountability To Humanity’ On Pharma IP 

The Impact of Free Trade Agreements between Developed and Developing Countries on Economic Development in Developing Countries: A Rapid Evidence Assessment 

The Impact of Publicly Supported Private Finance on Development And Poverty Reduction In Africa: Case of Rwanda & Zambia 

Refugee and migrant crisis 

EU turning blind eye to violence against women migrants  

WHO Officially Declares Sierra Leone Ebola-Free 

An insecticide-treated bed-net campaign and childhood malaria in Burkina Faso 

Ban appoints ‘veteran UN senior leader’ Benomar as his Special Adviser 

Is the World Bank’s Inspection Panel working the way it should? 

AIIB chief reveals global ambitions 

Anti-TTIP petition signed by 3 million people 

Making trade and environment policies work for Africa 

Facility-based active management of the third stage of labour: assessment of quality in six countries in sub-Saharan Africa 

Restricted aid access pushes parts of South Sudan back to the brink of famine 

Local innovations and country ownership for sustainable development 

Implementation of information and communication technologies for health in Bangladesh 

Is a Blame-the-Victim Mentality Choking off Funding for Lung Cancer Research? 

The right to water in the slums of Mumbai, India 

Rising temperatures could drive 100m into extreme poverty, World Bank warns 

Averting climate change’s health effects in Fiji 

Laudato Si’ Encyclical letter by Pope Francis on Care for our Common Home – Chapter three 

Technology in the 2015 Paris Climate Agreement and beyond

Breaking News: Link 165

Breaking News Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

medusa

Breaking News: Link 165

 

TPP: Up with Corporate Profits Outweighing Equity in Health! 

Text of the Trans-Pacific Partnership (released by TPP Parties on 5 November 2015) 

Despite assurances to contrary, intellectual property covered asset for TPP ISDS mechanism 

TPP Text Is Out, Finally, With Lots Of Bilateral Specialities  

‘One Battleship Has Arrived In Port’ – A Japanese View On The TPP 

UNISDR Science and Technology Conference on the Implementation of the Sendai Framework for Disaster Risk Reduction 2015-2030 

17 Year Exemption From Pharmaceutical Patents Agreed At WTO – TWN 

MSF responds to least-developed country IP exemption deal

A New Prize Aims to Fire Up Open Science for Health 

Top European donors: What you need to know 

Climate action thought experiment: Why don’t we just squish all of the continents together? 

Don’t wait for Paris summit to improve health 

Will the COP21 Succeed? 

The Tough Realities of the Paris Climate Talks 

Laudato Si’ Encyclical letter by Pope Francis on Care for our Common Home – Chapter two 

World’s climate pledges not yet enough to avoid dangerous warming – UN 

U.N. climate fund approves first projects ahead of Paris summit 

Health Affairs November Issue: Food And Health 

MPTs Combine Contraception With HIV And Other STI Prevention 

One year after Ebola crisis: impact of the disease is far from over 

Access to hepatitis C medicines 

Tuberculosis control in China: use of modelling to develop targets and policies 

Cost–effectiveness of a comprehensive programme for drug-resistant tuberculosis in China 

An insecticide-treated bed-net campaign and childhood malaria in Burkina Faso 

Salute e Informazione: così aiutiamo l’Africa 

PRIMA LE MAMME E I BAMBINI CUAMM ANNUAL MEETING 2015 Verona, Aula Magna dell’Università, sabato 21 novembre 2015 ore 10 – 13 

Human Rights Reader 373 

TPP: Up with Corporate Profits Outweighing Equity in Health!

The TPP case just represents the tip of the iceberg for the underhanded tactics to ensure that countries accept IP clauses that go beyond the full extension they have a right to under the WTO’s TRIPS. This context entails that TPP involved governments should, as per MSF words, “….carefully consider before they sign on the dotted line whether this is the direction they want to take on access to affordable medicines and the promotion of biomedical innovation...”

MINOLTA DIGITAL CAMERA

by Daniele Dionisio*

Policies for Equitable Access to Health – PEAH

TPP: Up with Corporate Profits Outweighing Equity in Health!

 

On 5 October 2015, ministers from Pacific countries clinched hard-fought, five-year Trans-Pacific Partnership, or TPP, trade agreement negotiations as the largest pact of its kind outside the World Trade Organization (WTO). The 12 countries involved – Australia, Brunei, Canada, Chile, Japan, Malaysia, Mexico, New Zealand, Peru, Singapore, the United States (US), and Vietnam – are home, indeed, to almost 800 million people and represent nearly 40 percent of the global economy.

The talks were promoted by the US to enhancing free trade in the Pacific realm by addressing global trade issues (including piracy and counterfeiting) and raising standards by taking into account the implications for the multilateral trade system and the different economic levels and needs of participating countries.

Disappointingly, the negotiations were shrouded in unprecedented lack of transparency and unbalanced secrecy level, whereby, as reported [here] and [here], the public was frozen out, US Congress members were severely limited in their access to treaty-related documents at a time when pharmaceutical and content industries sat on the IP advisory committee as corporate representatives, while smaller innovators and generics companies did not.

As such, it is unexpected news that, under recent decision by the federal district court in Manhattan, the Office of the United States Trade Representative (USTR) has been ordered to provide justification for withholding from a Freedom of Information Act request the communications with its industry advisors as confidential commercial or financial information in the lead-up to TPP agreement completion.

On 5 November 2015, the full text of the agreement was released by TPP Parties. Now it will have to be public for several weeks or months before being considered by the domestic parliaments of participating economies for ratification, implementation and, finally, entry into force.

Yet, the road ahead remains an arduous one given allegations that the agreement serves the interest of the wealthiest, caters to the needs of big industry rather than the citizens of member nations, and protects monopolistic interests now that, on a world scale, corporate profits outweigh any commitment to the global human rights  and equitable access to health [here] [here] and [here].

As argued, … The Obama Administration’s most important objective in this [TPP] negotiation was to raise the prices for drugs, vaccines and medical devices, worldwide, and they have no doubt achieved that objective, albeit not to the degree that meets every single one of the pharmaceuticals and medical device company asks….

A case in point, the minimum period for exclusivity data protection on biologic drugs was an harsh contention area in the final TPP negotiation days owing to the profit  interests of a number of corporations (e.g., Pfizer Inc, Roche Group’s Genentech and Japan’s Takeda Pharmaceutical Co, among others) relevant to state-of-the-art vaccines, anti-toxins, blood or blood products for transfusion, gene therapies, and cellular therapies.

As contended …..the real truth to the matter is that biologics are in the TPP because they represent big money for pharmaceutical companies as new chemically synthesized drugs offer less of a chance for “blockbuster” drugs than biologics. The global biopharmaceuticals market was valued at US$161,851.6 billion in 2014 and is expected to expand at  rate of 9.4 per cent to reach US$278,232.9 billion by 2020. Other studies believe the global market biologics will reach $386.7-billion by the end of 2019. Further, biologics are expected to account for approximately 17 per cent of total global spending on medicines by 2016 and reach an overall market value of $200 billion to $210 billion in 2016, up from $157 billion in 2011. Biologics provided roughly 22 per cent of the Big Pharma companies’ sales in 2013, will likely rise to 32 per cent by 2023. While promising in their potential to treat diseases ranging from cancer to rheumatoid arthritis, such drugs are significantly costly, with the Brookings Institution finding that these can cost up to 22 times the price of chemical drugs.

Unfortunately, though developing “biosimilars” (as “follow-ons” to an original biologic) would dramatically knock prices down, the US 12- year exclusivity data protection law currently makes that biosimilars cannot be approved during the period if they rely on the data used for the original biologic.

Relevantly, though the standing power of their counterparts has forced the US negotiators to fall short of demand and accept TPP rules that allow for a minimum five-year standard to eight years of data protection, regrettably, as stated,.… this is still the longest term of data protection ever enshrined by treaty, and will unquestionably hurt developing countries.

No surprise, the Big Pharma lobby and its Congressional supporters were unhappy with the TPP terms above. Does unhappiness explain why the US  has opposed a LDC Group’s request for an indefinite exemption from trade rules on pharmaceuticals?

The TPP deal has been dubbed as being transformational not just for the Asia-Pacific region, but also for the global economy at a time when, with new membership requests seemingly in the offing, the TPP terms are feared to influence still underway trade deals such as, among others, the EU-US Transatlantic Trade and Investment Partnership (or TTIP), and the EU-Japan, EU-India FTA negotiations.

As for India case, the concerns definitely outweigh optimism now that an ongoing breakthrough of multinational drug corporations in the country couples with protectionist US and EU policies, with India’s obligations as a WTO member, and with pressures on India’s government towards adopting IPRs beyond the Trade-Related Aspects of Intellectual Property Rights Agreement (or TRIPS) and strengthened enforcement mechanisms as the keys to foreign investments and innovation.

Overall, these circumstances put India’s freedom in jeopardy  as an independent  provider of affordable medicines for domestic and resource-limited countries’ needs

Relevantly, the chapter 18 (Intellectual Property) in the agreement confirms that, in spite of some lip service, the US has been pursuing a TRIPS-plus, corporations friendly policy over TPP negotiators  even though, just in the aftermath of the clinched pact, the USTR office stated that the IP chapter “reaffirms Parties’ commitment to the WTO’s 2001 Declaration on the TRIPS Agreement and Public Health, and in particular confirms that Parties are not prevented from taking measures to protect public health, including in the case of epidemics such as HIV/AIDS” .

Admittedly, the chapter largely grounds on TRIPS-plus measures including patents for new uses (the so-called ever-greening), granting of patents on medicines even in the absence of improved therapeutic effects, data/regulatory monopolies on clinical trial data (data exclusivity), patent term extensions (supposedly to compensate patent holders for delays in getting regulatory  approval), as well as enhanced mandatory injunctions for patent infringement and strong border measures.

As such, IP protection enforcement provisions, which make up a broad section of IP chapter, not only re-present but even exacerbate the provisions from the shelved ACTA treaty.

As would be the case for counterfeit trademark goods that are meant to be, for IP chapter purposes, .. any goods, including packaging, bearing without authorization a trademark that is identical to the trademark validly registered in respect of such goods, or that cannot be distinguished in its essential aspects from such a trademark;….

As regards the sectors to packaging and labelling of medicines, the impending threat of the definition above binds up with its potential to affect the patent holders’ access to the market at a time when the legislation against counterfeit and substandard medicines too often does not address quality issues, but instead is aimed at protecting the commercial interests of brand-name manufacturers.

Under these circumstances, it would make it easier for a claim to be lodged by the right holder against an infringer or alleged infringer for nullifying or eroding benefits by applying packaging and labelling models that, despite fair trading and full alignment with TRIPS requirements, are deemed to be insufficiently distinguishable or fraudulent.

The IP chapter enforcement provisions also contend that…. each Party shall provide that, in civil judicial proceedings concerning the enforcement of an intellectual property right, its judicial authorities have the authority, on a justified request of the right holder, to order the infringer or, in the alternative, the alleged infringer, to provide to the right holder or to the judicial authorities, at least for the purpose of collecting evidence, relevant information…. regarding any person involved in any aspect of the infringement or alleged infringement and the means of production or the channels of distribution of the infringing or allegedly infringing goods or services, including the identification of third persons alleged to be involved in the production and distribution of the goods or services and of their channels of distribution.

As such, TPP targets third parties by exposing them to the risk of punitive action also in trademark and patent infringement allegations.  As regards non-discriminatory access to medicines, this could play as an unfair deterrent to anyone engaged in the production, sale and distribution of affordable, high quality generic medicines including treatment providers like MSF, suppliers of active pharmaceutical ingredients used for rolling out generic medicines, as well as distributors and retailers who stock generic medicines.

Moreover, as regards border measures and criminal procedures and penalties relevant to products under infringement allegations, IP chapter terms appear unreliably vague or extortionate when stating that:

-Each Party shall provide that its competent authorities may initiate border measures ex officio [i.e., without the need of a formal complaint from a third party or right holder] with respect to goods under customs control that are: (a) imported; (b) destined for export; or (c) in-transit and that are suspected of being counterfeit trademark goods…

– Each Party shall adopt or maintain a procedure by which its competent authorities may determine within a reasonable period of time after the initiation of the procedures…whether the suspect goods infringe an intellectual property right.

– If a Party requires identification of items subject to seizure….., that Party shall not require the items to be described in greater detail than necessary to identify them for the purpose of seizure….

Furthermore, the Damocles’ sword of an investor state system enforcement as regards access to medicines cannot be underestimated since USTR office terms clearly state that “the dispute settlement mechanism created in chapter 28 [of the agreement] applies across the TPP, with few specific exceptions”.

Consequently, being not explicitly excused from, the chapter 18 (Intellectual Property) is undoubtedly subject, as just argued, to the dispute settlement mechanism whereby private companies located in the territory of any TPP disputing Party are allowed to sue governments directly for policies the governments take.

In this regard, many forms of government regulations, including price cuts of medicines, could be argued not to conflict with the TRIPS agreement, yet to make pointless or erode the expectations of the patent owners.  Relevant risk sectors also include tariffs on medicines, as would be the case should a country that has agreed to reduce tariffs on an imported product later subsidize home manufacturing of the same medicine. A complaint against this country under an investor state system would be allowed to re-establish the conditions of competition in the original transaction.

These prospects appear ominously alarming  and compound fear that the afterglow from the TPP’s completion could lead other trade initiatives on a world scale to adopt “investor-state mechanism” friendly terms.

Last but not least, while TPP focuses on expanding IPRs and defends market-driven rather than needs-driven rules, it, as reported, …also fails to give attention to innovative approaches to stimulating R&D for new drugs, vaccines and medical devices that delink R&D costs from product prices. Such new approaches would ensure the development of needed new treatments at affordable prices.

Taken together, all insights here suggest that the TPP case just represents the tip of the iceberg for the underhanded tactics to ensure that countries accept IP clauses that go beyond the full extension they have a right to under the WTO’s TRIPS.

On these grounds, what expectations now that US pressure  will certainly force through its position to allow the TPP to be ratified by the national parliaments, hence undermining access to  care and lifesaving medicines for millions of people in resource-constrained settings?

This context entails that TPP involved governments should, as per MSF words, “….carefully consider before they sign on the dotted line whether this is the direction they want to take on access to affordable medicines and the promotion of biomedical innovation. The negative impact of the TPP on public health will be enormous, be felt for years to come and it will not be limited to the current 12 TPP countries, as it is a dangerous blueprint for future agreements.”

 

——————————————————-

*Daniele Dionisio is a member of the European Parliament Working Group on Innovation, Access to Medicines and Poverty-Related Diseases. He is an advisor for “Medicines for the Developing Countries” for the Italian Society for Infectious and Tropical Diseases (SIMIT), and former director of the Infectious Disease Division at the Pistoia City Hospital (Italy). Dionisio is Head of the research project PEAH – Policies for Equitable Access to Health. He may be reached at d.dionisio@tiscali.it http://www.peah.it/ https://twitter.com/DanieleDionisio

 

 

Acqua e Servizi Igienici: in Kenya un Miraggio per Molti

Il libero accesso a fonti di acqua potabile e ad idonei servizi igienici è un diritto universale. Sfortunatamente, la realtà che riscontriamo ci racconta una storia diversa. Milioni di persone muoiono ogni anno per le difficoltà che alcuni Governi riscontrano nel garantire tale diritto. Il Kenya è fra questi. Molto è stato fatto da questo Governo, ma maggiori sforzi devono essere profusi

Pietro_picture-150x150

by Pietro Dionisio

Degree in Political Science, International Relations

Cesare Alfieri School, University of Florence, Italy

Acqua e Servizi Igienici: in Kenya un Miraggio per Molti

 

Una questione internazionale

La disponibilità adeguata di acqua potabile e di servizi igienici rappresenta un elemento basico per potere garantire un livello di salute dignitoso ad una popolazione. La mancanza di tale fornitura di servizi è alla base delle ricorrenze infettive che affliggono milioni di persone nei Paesi poveri. A farne maggiormente le spese è la fascia infantile spesso colpita da forme gravi di diarrea dovuta a mancanza di igiene o di acqua potabile; le stime parlano di circa 1,5 milioni di minori che ogni anno muoiono per infezioni correlate.

Tale questione è sentita come di vitale importanza dalla comunità internazionale. Negli ultimi anni i governi, anche dei Paesi in via di sviluppo, hanno cercato di promuovere politiche atte alla risoluzione del problema. E le Nazioni Unite, prima con gli MDGs (Millennium Development Goals), e poi con gli SDGs (Sustainable Development Goals), hanno posto un forte accento sull’argomento dimostrando come il garantire un facile accesso ad acqua potabile e opportuni servizi igienici non sia un mero esercizio retorico ma una volontà pratica e concreta.

L’interesse su tale argomento è ovvio solo prendendo in considerazione gli effetti positivi che conseguirebbero ad un impegno coerente per colmare il gap. Se i governi afflitti da questa piaga investissero nel settore, avrebbero la possibilità di recuperare l’investimento ottenendo una popolazione più sana e quindi più produttiva. Inoltre, il capitale umano a disposizione ne risentirebbe positivamente poiché i minori avrebbero la possibilità di accedere allo studio e alla frequenza scolastica, mentre la conseguente riduzione dei livelli di povertà in una popolazione più sana comporterebbe la flessione della spesa sanitaria pubblica.

Ne risulterebbero volumi di risparmio che potrebbero essere spesi in consumi interni così da produrre un ulteriore beneficio economico.

Sfortunatamente, queste prospettive non sono alla portata di tutti. Oggi, sebbene a livello mondiale il target MDG relativo all’accesso a fonti di acqua potabile sia stato raggiunto, ancora alcune regioni faticano a garantire tale diritto.

Il caso Kenya

La regione Sub-Sahariana è una di queste. In essa, solo il 68% della popolazione ha accesso ad acqua potabile, e molti Stati stentano a garantire questo diritto.

Il Kenya non è da meno. Su una popolazione complessiva di circa 47 milioni di persone, il 38% non ha accesso ad acqua potabile e il 5,3% delle morti totali è riconducibile ad infezioni contratte tramite l’assunzione di acqua contaminata o  per mancanza di consoni servizi igienici. Per decenni, la scarsità di acqua è stato uno dei principali problemi del Paese. Frequenti siccità, un sistema idrico insufficiente, una deforestazione indiscriminata, la contaminazione dell’acqua a disposizione, il tutto unito ad un aumento della domanda dovuto all’incremento della popolazione, hanno fatto sì che il problema assumesse proporzioni considerevoli.

Negli ultimi quindici anni il governo Keniota ha cercato di superare il deficit ma ad oggi, sebbene qualche miglioramento sia stato ottenuto, ancora molto deve essere fatto.

Come accennato, gli sforzi promossi sono stati notevoli: ne sono esempi il “Water Act 2002” e la “Costituzione del Kenya del 2010” dove all’Art. 43.1 e all’Art. 56 si fa esplicito riferimento alla volontà di garantire a tutti l’accesso a quantità adeguate di acqua potabile e servizi igienici e sanitari.

Le politiche implementate hanno portato ad un miglioramento della situazione. I dati riferiti dal Governo Keniota affermano come dal 2008 al 2013 la proporzione di popolazione che ha accesso a fonti di acqua potabile sia cresciuta dal 59% al 62% e, sempre nel 2013, è il 55% della popolazione rurale che riesce ad approvvigionarsi a fonti di acqua sicura.

L’impegno del Governo è considerevole. Gli obiettivi che le varie strategie si propongono di raggiungere riguardano l’ottimizzazione della gestione dei lavori e dei piani di investimento, l’aumento dei fondi da destinare al settore, la promozione di interventi volti a garantire fonti idriche e igieniche per i gruppi più svantaggiati (soprattutto nelle zone rurali), e l’aumento di lavoratori formati per potere sviluppare il settore stesso e rendere le riforme sostenibili nel lungo periodo.

Oltre a questo, il Governo Keniota è impegnato nella costruzione di un serie di dighe così da incrementare l’approvvigionamento idrico mediante progetti quali, ad esempio, il “Background-Badasa Dam Project”, il “Maruba Dam Project”, il “Chemususu Dam Project” e il “Umaa Dam Project”.

Questi progetti fanno seguito al “Mwache Multipurpose Dam Project” del 2014 le cui finalità sono molteplici. L’obiettivo principale è la costruzione della diga, quale prerequisito per la realizzazione  di infrastrutture idonee a migliorare la fornitura di acqua e servizi igienici nelle contee di Mombasa e Kwale, e per l’ottimizzazione dell’intero sistema di irrigazione locale.

Una agenda da ampliare

Nonostante tutti gli sforzi profusi, non è ipotizzabile che un Governo possa considerarsi soddisfatto se il 38% della sua popolazione ancora non ha accesso ad acqua potabile e ad appropriati servizi igienici. Purtroppo la realtà del Paese ci racconta una storia dove gli investimenti nel settore non possono assolutamente ritenersi sufficienti e dove il gap tra offerta di fondi e la domanda fa sì che ci sia più di un dubbio circa il mantenimento dei servizi esistenti. Tali presupposti ci possono solo fare immaginare le problematiche che il Governo incontra  per l’implementazione di nuovi progetti!

Al fine di garantire un miglioramento del persistente deficit attuale alcune misure sarebbero richieste. Un maggiore coinvolgimento della comunità internazionale potrebbe garantire fondi più consistenti.  L’apporto congiunto di politiche più chiare e di una strategia più definita, renderebbe il miglioramento del settore un obiettivo realmente conseguibile.

In aggiunta, il sistema di valutazione e monitoraggio dovrebbe essere rafforzato al fine di realizzare efficaci politiche di intervento ad hoc.

Nel contempo dovrebbero essere poste in atto permanenti campagne informative per la popolazione al fine di infondere consapevolezza sui rischi connessi alla assunzione di acqua non potabile.

In conclusione, se i progressi conseguiti ad oggi dal governo Keniota, certamente considerevoli,  fanno ben sperare per il futuro, è chiaro che ulteriori energie devono essere profuse affinché il libero accesso ad acqua potabile e a servizi igienici, quale diritto inalienabile di ciascuno, sia davvero garantito!

 

 

Addressing Health Inequalities through the United Nations’ Sendai Framework for Disaster Risk Reduction 2015-2030

This article focuses on the Sendai Framework for Disaster Risk Reduction 2015-2030 and how it addresses health and vulnerability. It is hoped that this short report will assist communities of research, policy in understanding the aim of the Sendai Framework and identifying synergies and foster collaboration, particularly through research and evidence-translation for policy makers

Amina Aitsi Selmi

by Amina Aitsi-Selmi

 MBBChir MA(cantab) MRCP MPH MFPH PhD  

Consultant in International Public Health, Global Disaster Risk Reduction/International Public Health, Public Health England

Addressing Health Inequalities through the United Nations’ Sendai Framework for Disaster Risk Reduction 2015-2030

 

Introduction

The year 2015 is a crucial year in global policy with the publication of three landmark UN agreements: 1) the Sendai Framework for Disaster Risk Reduction 2015-2030 (agreed by 187 Member States after negotiations at the World Conference on Disaster Risk Reduction in March 2015);[1] 2) the Sustainable Development Goals (SDGs)[2] which are the successors of the Millennium Development Goals (agreed in September); and the climate change agreements (to be agreed in December). The success of these global agreements is partly dependent on ensuring coherence and building on synergies to avoid duplication and encourage joint initiatives. For example SDG targets 1.5, 2.4, 11.b, 11.5 and 13.1 all pertain to disaster risk reduction (DRR) and are, therefore, areas of synergy with the Sendai Framework.[3]

A comprehensive approach to future economic development – in low-, middle- and high-income countries – must ensure that future economic activity has people’s wellbeing and the environment’s preservation at its heart. It is encouraging that, so far, the agreements acknowledge the role of unmanaged development processes in increasing the risk of disasters and disease and the need to address vulnerability by influencing wider socioeconomic factors. This article focuses on the Sendai Framework and how it addresses health and vulnerability. It is hoped that this short report will assist communities of research, policy in understanding the aim of the Sendai Framework and identifying synergies and foster collaboration, particularly through research and evidence-translation for policy makers.

Health in the Sendai Framework

The Sendai framework for disaster risk reduction 2015–2030 has a substantial emphasis on health – much more so than its predecessor, the Hyogo framework for action 2005–2015.[4] There are more than 30 explicit references to health (compared to three in its predecessor), referring to the implementation of an all-hazards approach to managing disaster risk including links to epidemics and pandemics, the International Health Regulations and to rehabilitation as part of disaster recovery and health system resilience.[5] These are welcome links as disasters often exacerbate the causes of ill-health, whether through direct physical injury, mental health sequelae, infectious disease outbreaks through damage to water and sanitation infrastructure or disruption to health service access which impact those with chronic disease.[6]

Over the next 15 years, the framework’s main objective is to achieve the “substantial reduction of disaster risk and losses in lives, livelihoods and health and in the economic, physical, social, cultural and environmental assets of persons, businesses, communities and countries.” Voluntary commitments with a specific public health focus that have been agreed include: enhancing the resilience of national health systems through training and capacity development; improving the resilience of new and existing critical infrastructure, including hospitals, to ensure that they remain safe, effective and operational during and after disasters, to provide live-saving and essential services; establishing a mechanism of case registry and a database of mortality caused by disaster to improve the prevention of morbidity and mortality and enhancing recovery schemes to provide psychosocial support and mental health services for all people in need; enhancing cooperation between health authorities and other relevant stakeholders to strengthen country capacity for disaster risk management for health; and the implementation of the International health regulations (2005).

Disaster impacts are strongly influenced by physical, social, economic and environmental factors apparent as underlying vulnerability from poverty, inequity and poor urban planning and land use.[7] The Sendai Framework acknowledges that reducing disaster risk requires concerted action across a wide range of sectors, institutions and disciplines. In alignment with the Social Determinants of Health approach,[8] which calls for intervention on the wider determinants that impact individual lives and health, reducing disaster risk is, therefore, relevant within and beyond the health sector.

Vulnerability in the Sendai Framework

The United Nations Office for Disaster Risk Reduction (UNISDR) defines vulnerability as “The conditions determined by physical, social, economic and environmental factors or processes, which increase the susceptibility of a community to the impact of hazards”.[9] Vulnerability may vary within a population by subgroup (e.g. income level or type of livelihood) and may change over time, adding complexity to vulnerability measurement.[10]

An important area of progress is reflected in Priority 1 of the Sendai Framework: understanding risk. Risk assessment and modelling that incorporate all dimensions of risk including vulnerability can help to communicate usable risk information to users and assist decision-makers in understanding the potential impact of disasters and highlighting effective policies to reduce risk, increase preparedness, and improve response and recovery.

Traditionally, the focus of risk assessments has been on (natural) hazards or physical infrastructure alone. However, the Sendai Framework gives prominence to the vulnerability of populations, communities and groups and calls on the scientific community and its partners to: discuss and identify main gaps and challenges in the development of vulnerability data and models, considering physical, socio-economic, institutional and environmental factors; identify needs for improved understanding and models for community resilience; and promote enhanced collection, availability and dissemination of datasets fundamental to assessing exposure and vulnerability, such as up-to-date disaggregated census data, building typologies, poverty and household surveys, sectoral data (e.g., school locations and attributes) and systematic post-disaster analysis of building and infrastructure failure and socio-economic impacts on communities; but also: strengthening the design and implementation of inclusive policies and social safety-net mechanisms, including access to basic health care services towards the eradication of poverty; finding durable solutions in the post-disaster phase to empower and assist people disproportionately affected by disasters, including those with life threatening and chronic disease. The latter recommendation will be particularly important in the coming years as non-communicable diseases continue to rise in low- and middle-income countries.

Four distinct and largely independent research and policy communities – disaster risk reduction, climate change adaptation, environmental management and poverty reduction have been working to reduce vulnerability to hazards but face challenges in terms of facilitating learning and exchanging information.[11]  In addressing these challenges to produce useful, usable and used risk information that incorporates vulnerability as a critical dimension of risk, different communities of producers and users of information across sectors and disciplines will need to work together at all levels, local, national, regional and global to ensure the aspirations of the Sendai Framework (and its closely related policy agreements of 2015) are achieved.

Next steps: convening the scientific community to leverage science for life-saving policy

The Sendai Framework strongly endorses the role of science and the importance of the scientific community in supporting the implementation of the framework over the next 15 years. Multidisciplinary research is highlighted as critical to producing science that is used, usable and used through improved databases, the use of baselines and disaggregated data, more effective dissemination of evidence and knowledge and capacity building to name but a few areas of recommendation. The framework is a call to all scientists to collaborate in making a positive difference to ‘lives, livelihoods and health’. One of the Sendai Framework’s priorities for action is: to promote investments in innovation and technology development in long-term, multihazard and solution-driven research in disaster risk management to address gaps, obstacles, interdependencies and social, economic, educational and environmental challenges and disaster risks.

In order to offer an opportunity to explore the implications for the scientific community of the Sendai Framework, the United Nations Office for Disaster Risk Reduction (UNISDR) is organising an international conference to launch a science and technology global partnership and develop a 15 year road map for the global science and technology community to support the implementation of the Sendai Framework until 2030.  The conference will take place in Geneva, 27-29th of January 2016 (For further information and call to abstracts, see http://www.unisdr.org/partners/academia-research/conference/2016/).

References

  1. UNISDR. 2015b. Sendai framework for disaster risk reduction 2015–2030. In: UN world conference on disaster risk reduction, 2015 March 14–18, Sendai, Japan. Geneva: United Nations Office for Disaster Risk Reduction; 2015. Available at http://www.unisdr.org/files/43291_sendaiframeworkfordrren.pdf
  2. The Sustainable Development Goals. Available at https://sustainabledevelopment.un.org/topics [Accessed 18 October 2015].
  3. Aitsi-Selmi A, Murray M. Ensure healthy lives and promote well-being for all at all ages. ICSU, ISSC (2015): Review of the Sustainable Development Goals: The Science Perspective. Paris: International Council for Science (ICSU). Available at http://www.icsu.org/publications/reports-and-reviews/review-of-targets-for-the-sustainable-development-goals-the-science-perspective-2015/SDG-Report.pdf [Accessed 18 October 2015].
  4. UNISDR. The Hyogo Framework for Action (HFA). Available from http://www.unisdr.org/we/coordinate/hfa  [Accessed 18 January 2015]. 2005.
  5. Aitsi-Selmi A MV. The Sendai framework: disaster risk reduction through a health lens. Bulletin of the World Health Organization 2015;93:362.
  6. Aitsi-Selmi A, Egawa S, Sasaki H, Wannous C, Murray V. The Sendai Framework for Disaster Risk Reduction: Renewing the Global Commitment to People’s Resilience, Health, and Well-being. International Journal of Disaster Risk Science. 2015;6:164-76. doi: 10.1007/s13753-015-0050-9.
  7. UNISDR. Proposed Elements for Consideration in the Post‐2015 Framework for Disaster Risk Reduction: By the UN Special Representative of the Secretary‐General for Disaster Risk Reduction. Geneva: United Nations Office for Disaster Risk Reduction; 2013. Available from: http://www.preventionweb.net/files/35888_srsgelements.pdf [cited 18 October 2015]. 2013.
  8. CSDH (2008). Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva, World Health Organization.
  9. UNISDR. 2009. Terminology on Disaster Risk Reduction. Available at http://www.unisdr.org/we/inform/publications/7817 [Accessed 19 June 2015].
  10. Birkmann Jr, Pelling M. Measuring vulnerability to natural hazards : towards disaster resilient societies Tokyo: United Nations University; 2006.
  11. Thomalla F, Downing T, Spanger-Siegfried E, Han G, Rockstrom J. Reducing hazard vulnerability: towards a common approach between disaster risk reduction and climate adaptation. Disasters. 2006;30(1):39-48. doi: 10.1111/j.1467-9523.2006.00305.x. PubMed PMID: 16512860.

 

Breaking News: Link 164

Breaking News Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

medusa

Breaking News: Link 164

 

Court Orders USTR To Justify Industry Advisor Confidentiality In TPP 

Health Equity: the Key for Transformational Change    

Equidad en Salud: La llave para un Cambio Transformacional 

Human Rights Reader 372 

To Achieve Global Health “Convergence,” an Evolving Role for Health Aid 

PROGRAMMA DELL’ OTTAVO CONGRESSO DI MEDICINA DEMOCRATICA 19-21 NOVEMBRE – FIRENZE 

EUROPEAN COMMISSION Call for proposals 2016 — EAC/A04/2015 Erasmus+ programme (2015/C 347/06) 

TACD: It is not healthy: Mending the broken medicines innovation model December 2,  12:45 pm – 3:00 pm 

The Regulatory Burden Of The Priority Review Voucher Program 

The High Price of Medicine 

Harvard’s Oct. 23, 2015 forum on “Drug Pricing: Public Health Implications” 

South Africa Should Override Patent on Key HIV Medicine After Widespread Stock Out Problem

WIPO, WTO, WHO Heads Underline Need For Better Access To Medicines 

WHO Director-General addresses symposium on intellectual property and trade 

Solving malnutrition: Public money for public problems 

Food & Health  

If You’re Behind the Crowd on Crowdfunding 

India-Africa Summit: Bringing Foreign Policy Back Home 

China’s aid splurge fails to bridge credibility gap in Africa 

How Africa can build inclusive, safe and sustainable cities 

Land Rights in Poor Countries Is a Hot Cause for More Funders. Here’s Why 

ACP countries adopt declaration on upcoming WTO ministerial 

TB is now leading global infectious killer

Embattled UN climate talks send complex draft text to Paris meet 

Laudato Si’ Encyclical letter by Pope Francis on Care for our Common Home – Chapter one  

 

 

Prison Health 2: Solutions

Prison health is public health.  Only a small percentage of prisoners are incarcerated for life. Diseases are not stymied by prison walls. There is no distinct line between the health of prisoners and that of the general population. This article highlights a few projects that are working to address the underserved population of prisoners and ex-prisoners, particularly those who use drugs

Corie Leifer

by Corie Leifer*, MSc.

Project and Office Manager

AIDS Foundation East-West (AFEW)

 Prison Health Article Number 2 Solutions

 

An article earlier this year concentrated on the epidemic of HIV, TB, and viral Hepatitis in prisons around the world and the potential contributing factors to this problem. A project review was conducted to find a few projects that are working to address the underserved population of prisoners and ex-prisoners, particularly those who use drugs. Alternatively, some of these projects serve people who use drugs, including those in prison. The information found in this article is mainly a result of internet research and email correspondence with project and program managers. 

Health in Prisons Programme 

This high-level project initiated by the World Health Organization (WHO) seeks to guide and connect Ministries of Health, Justice and Interior to “help promote health and address health inequalities in prisons.” Every year for the last twenty years, the Health in Prisons Programme (HIPP) has organized regional conferences to facilitate communication and sharing of best practices between the different stakeholders working to improve health in prisons. Through HIPP, WHO member states are provided with technical assistance in creating prison health systems linked to the larger public health system. Also through this program, guidance is given on how to address all important issues of prison health like HIV/AIDS, viral hepatitis, tuberculosis, injecting drug use, and mental health. By encouraging partnerships between public health systems, international nongovernmental organizations and prison health systems, HIPP aims to solve the problem of prison health systems that are developed and maintained independent of the larger health system of a country. Furthermore, by incorporating prison health systems into the larger public health system, standards are established regarding human rights and medical ethics, and all prison health services.

HIV React Project 

USAID’s HIV React project works to reduce HIV transmission in Tajikistan, the Kyrgyz Republic, and Kazakhstan among key populations in detention and post-detention settings. The project provides technical assistance, training, transitional client management and prevention services to reduce HIV transmission among prisoners and post release inmates in these three countries and strengthen the quality of narcology services and their linkages with AIDS centers and legal and social support services for prisoners and ex-prisoners. This project is implemented by AIDS Foundation East-West (AFEW) and contributes to improving cooperation between the penitentiary system, NGOs and civil health services such as AIDS and Narcological Centers. Furthermore, through this project, trainings for prison-based health care workers in the field of narcology were offered, increasing the knowledge of these specialists.  An updated version of AFEW’s “ START Plus: transitional client management program” offering HIV and TB prevention among prisoners and provision of comprehensive package of health and social services for pre and post-release prisoners in Tajikistan has been officially introduced by Head Administration of Penitentiary System of the Ministry of Justice of Tajikistan. One of the key components of this project is through-care, the methodology on which it is based. Through-care provides a support worker who helps the client navigate through the social system and helps him or her to access services from the time shortly before their release from prison until many months into the social re-integration process. Also, AFEW-Tajikistan has recently received official approval from the Ministry of Health and Social Protection to introduce VCT at their practice and practices of other Tajik NGOs. This will help increase the use of HIV counseling and rapid-testing service, as it is no longer only available in penal facilities and for key populations.

SECRET: Socio-Economic and Cultural Rights of Prisoners and Ex-prisoners in Tajikistan 

The SECRET project has been funded by the European Commission and the German Federal Ministry for Economic Cooperation and Development.  It is implemented by the Institute for International Cooperation of the German Adult Education Association (DVV International) at the Female Prison in Nurek town and 4 cities. The two-year project (2014-2015) serves female prisoners and ex-prisoners of both genders in Tajikistan. The overall goal of this project is to “contribute to the realization of social, economic, and cultural rights” for these disadvantaged populations. The specific objective of this project is to provide them with and expand access to opportunities, including vocational skills development, civic education, and personal development programs. This project has helped approximately 600 ex-prisoners to reintegrate into society by providing professional orientation and psychological and legal support through social reintegration service desks. 150 female prisoners have received training and vocational facilities and courses, offering more possibilities for them to reintegrate into society after their release. Furthermore, through this project, prison staff has received trainings on “international standards of custodial supervision and penitentiary psychology.”

African Prisons Project 

The African Prisons Project (APP) works in Uganda and Kenya to address the welfare, health, and education of detainees. In Uganda, as is the case in many places, prison health is not incorporated in the national health care system. The African Prisons Project aims to use the model of the national health care system within the prison system, utilizing a group of outreach workers known as Village Health Teams. The Prison Village Health Teams often work in prisons which house up to three times as many prisoners as their maximum capacity. In order to help resolve underlying causes of poor health conditions, APP is able to provide information and referrals to prisoners and to “empower prisoners, prisons’ staff and prison community members with relevant health knowledge.” Additionally, APP supports inmates living with HIV with nutritional supplements, which increases their adherence to Anti-Retroviral Treatment (ART) and helps mitigate its toxicity and side-effects. ART often causes a loss of appetite, mouth thrush, nausea and vomiting. The result is a lack of nutrition and a worsening of the condition. The additional proteins, vitamins, and minerals can improve the health of these patients and their quality of life.

Safer Return 

In Chicago, Illinois, in the United States, the Safer Return project worked to help former prisoners to successfully re-enter society and to prevent re-incarceration. Working with the Urban Institute and the John D. and Catherine T. MacArthur Foundation, the Safer Foundation designed and implemented this project from 2008-2013 in a neighborhood known as Garfield Park on the west side of Chicago. The Safer Return project worked with various community-based organizations with different specialties to provide a wide range of supportive services to people returning to Garfield Park from prison. These services aimed to work on three aspects of re-integration:

  • “Address the key needs of formerly incarcerated people and their families, such as job opportunities and stable housing.
  • Introduce innovative system enhancements, such as neighborhood‐based parole officers and case management services that include family members.
  • Remedy local conditions that hinder success by increasing access to social activities and role models.”

With a multitude of services to support former prisoners and their families provided by engaged community members and community-based organizations, the Safer Return project was able to “help returning prisoners shape better futures for themselves.” In the almost five years of the program, 727 former prisoners voluntarily enrolled to participate. There were many aspects of this project that contributed to its positive outcomes. Peer education and support, knowledgeable and accessible case managers, and job training and placement assistance were all crucial components of this project.

Conclusion

Prison health is public health. Only a small percentage of prisoners are incarcerated for life. Diseases are not stymied by prison walls. There is no distinct line between the health of prisoners and that of the general population. Prisoners come from the community and return to the community. It is important that prisoners receive equal rights to health and equal opportunities for success. These projects and many more like them are crucial to assisting in the transition from prison and re-integration into society.

 

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*Corie Leifer (Office Manager since January 2013), was born in 1981 in Connecticut, USA. After earning a bachelor degree in communications and another in nursing in the United States, she moved to the Netherlands in 2011 to earn a Master of Health Science degree with a focus on International Public Health from Vrije Universiteit in Amsterdam. During this study, Corie completed her internship at AFEW and subsequently joined AFEW as Office Manager. As a research intern, she investigated the use of SMS campaigns to reduce the spread of HIV/AIDS. Corie has international marketing and communications experience, having worked at Operation Smile, Inc. and Trader Publishing Company prior to returning to school. Corie is also a Registered Nurse licensed in the Commonwealth of Virginia, USA.

 

Understanding, Measuring and Acting on Health Equity

Measuring health equity challenges many of the present global concepts and policies on Health. The tragic death toll from global Health inequity (injustice) requires a deep transformation of concepts and dynamics towards the universal right to Health

Juan-Garay-244x300

by Juan Garay*

Head of Cooperation Section, Delegation of the European Union to Mexico

Understanding, Measuring and Acting on Health Equity

from just published book Health Equity: the Key for Transformational Change (Spanish version here)

 

As the XXIst century reveals, Humanity has reached a peak in inter and intergenerational inequity,  Health concepts and principles need to be revisited: the definition of Health needs to include equity and sustainability dimensions and  the lack of accountability in the guarantee of the right to Health calls to remind the International Covenant on Economic Cultural and Social Rights (ICECSRs) and its optional protocol as the true commitments to health.

We need to overcome the international denial of measuring Health equity (and instead describing inequalities). Measuring inequalities and acting on poverty only mitigate the root causes of ill health. If we measure inequity and ensure minimum dignity for all we will challenge the present international cooperation framework and progress towards a binding redistribution mechanism to enable the universal right to Health. Such approach would also challenge the present human development indicators as we need to  incorporate individual but also collective dimensions of our effects on others.

Health is a universal human right as recognized in the Universal Declaration of Human Rights (UDHR). Health equity -best feasible Health for all- is the main principle of global Health accepted by all countries as recognized in the founding objective of the World Health Organization. However, as the levels of best feasible Health have never been agreed upon, the state and trend of Health equity and inversely the burden of Health inequity have never been measured.

Daring to set best feasible Health standards for all, across and within countries, is essential to operationalize and measure the universal right to Health.

In order to set best feasible (and sustainable to expand the feasibility across generations) Health standards, we identified countries that for the last 70 years (UN available demographic statistics) have complied with three criteria: 1) life expectancy above the world´s weighted (by countries’ population sizes) average, 2) per capita GDP below the world´s weighted average (feasibility, countries above the world´s average cannot be models for all as resources would not be sufficient) and 3) carbon footprint below the planetary boundary (sustainability). This method can be applied at sub-national and regional levels.

Only fourteen countries [1] have constantly met the mentioned criteria. We analysed their average Health indicators disaggregated by age periods, sex, and across time, and enable the calculation of the burden of Health inequity by countries, ages, sex and time periods. Such analysis is represented in charts and maps which are only a small sample of the interactive database of maps and graphs of Global Health equity developed by the Equity Movement.

This analysis concludes that over one in three annual deaths worldwide are avoidable by global Health equity. In the last five-year period the annual average of avoidable deaths was over 17 million deaths, 2000 every hour. Most of the avoidable deaths took place in the countries with per capita GDP below the minimum income threshold defined by the Healthy-Feasible-Sustainable (HFS) models. Such minimum “dignity threshold”, given the average level of resources, allows the definition of a “hoarding threshold” and -between both dignity and hoarding thresholds- an economic equity zone compatible with the universal right to health (and possibly most other human rights).

This tragic death toll due to global injustice challenges the global economic and cooperation framework. The redistribution required to enable all persons in the world to have the chance to enjoy a globally feasible-sustainable minimum level of life expectancy challenges the far lower, unequitable and volatile levels of development “aid”.

The work ends by challenging also the global rating of development (as the Human Development Index) by introducing the dimensions of our effects on others (here or to come) through the effects of hoarding and/or exhausting natural and economic resources.

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*Juan Garay  is a medical doctor from Spain, specialized in internal medicine, infectious diseases and public health. Since the 80s, he has combined clinical, public health, research and design on health systems (as some of the early AIDS treatment programs in Africa), in many countries in Europe, Africa and America, with governments, universities and non-state actors.

In 2002 he joined the European Union, working initially in the design of EU health cooperation policies and programs. He gradually explored the roots of health in the areas of human rights -coordinating the work towards the EU external policy on children rights- and the multisectorial dimensions of health which led to his coordination in the development of the EU policy on global health. In relation to global health challenges, he has focused on research on global health equity in the last years. Since 2013 he works as head of EU cooperation in Mexico, with special emphasis on analysis and policy dialogue on social cohesion.

In parallel to his responsibilities in the EU, Juan Garay is professor of global health in Granada and Madrid, advisor to the South American Institute of Health Governance, visiting lecturer in UC Berkeley, as well as guest lecturer in several universities in America and Europe, where he continues research and academic activities in relation to health and social equity metrics.

 

[1] From higher to lower average life expectancy 1950-2010 : Cuba, Costa Rica, Albania, Armenia, Georgia, Belize, St Lucia, Sri Lanka,  Vietnam, Tonga, St Vincent, Paraguay, Grenada, and Colombia

 

Red Mundial Para el Diagnóstico Médico – Tulaitula Health Consulting Group

Red Mundial Para el Diagnóstico Médico - Tulaitula Health Consulting Group,Octubre 2015: Un sistema de información clínica para apoyar y facilitar el diagnóstico y tratamiento médicos en países con recursos limitados y en el resto del mundo

Bashir copertina

by Bashir Saiegh Saiegh DPH, MPH

Bashir photo

Fundador y CEO de Tulaitula Health Consulting Group

Red Mundial Para el Diagnóstico Médico

 English version: World Network for Medical Diagnosis_PEAH (1)

                                                                                 

RESUMEN DE LA IDEA PRINCIPAL

Se trata de construir una red médica basada en la innovación tecnológica y cuya finalidad sería la de lograr una alianza mundial entre los profesionales de la salud que contribuya a la reducción de las desigualdades sanitarias en todo el mundo, principalmente aquellas desigualdades derivadas de la escasez de acceso a conocimientos médicos avanzados, escasez de acceso a médicos especialistas y de otros profesionales sanitarios cualificados que padecen sobre todo las poblaciones de países pobres o en vías de desarrollo.

En definitiva, se trata de desarrollar e implementar un Sistema de Información Clínica patrocinado por una o más de las principales instituciones internacionales (OMS, Parlamento Europeo, Comisión Europea… etc.) para apoyar y facilitar el diagnóstico y tratamiento médicos en países sin recursos económicos suficientes con el propósito de transformar y mejorar el cuidado de la salud de sus poblaciones y promover una atención sanitaria basada en la evidencia de los datos. Se trataría de una red exclusiva para los profesionales sanitarios de todo el mundo cuya principal finalidad sería la de facilitar las interconsultas clínicas relacionadas con la salud de pacientes. De ella, podemos destacar los siguientes aspectos básicos:

  • Es una red exclusiva para profesionales sanitarios. Esto incluye inicialmente a todos los médicos (médicos de familia o de atención primaria, cirujanos y demás especialistas) además de enfermeras y matronas. Más tarde se incluirá al resto de trabajadores sanitarios “todas las personas que participan en las acciones cuya intención principal es mejorar la salud” (OMS – Informe Mundial de la Salud 2006).
  • Para unirse a la red, los médicos y demás profesionales sanitarios deben ser previamente identificados según la legislación vigente de cada país y de acuerdo a las normas de accesos y usos de la red.
  • Los profesionales que ejercen como consultores médicos no tienen ningún poder de decisión directa sobre la salud del paciente, por lo que estarán exentos de cualquier responsabilidad legal, sólo actúan como asesores en materia de salud.
  • En la interconsulta no se incluirá ningún dato que facilite la identificación personal de los pacientes.
  • La interconsulta se hará a través de un resumen de historia clínica electrónica del paciente.
  • Se podrán adjuntar imágenes, videos y otros documentos clínicos en soporte digital, siempre que no den lugar a la identificación personal del paciente.
  • El sistema se desarrollará en los principales idiomas de la OMS e incluirá un traductor para facilitar la interconsulta clínica entre los diferentes países.

En definitiva, y con el fin de alcanzar la excelencia operativa de la red, pondremos a disposición de las instituciones interesadas todos los detalles técnicos de este proyecto incluyendo todos los detalles de este nuevo modelo de interconsulta médica y el flujo de datos de principio a fin que hemos diseñado para implementar este circuito innovador en la atención especializada. Estos circuitos y flujos de datos se construyeron a partir de una nueva visión médica para mejorar los cuidados de la salud y sostenida, no sólo sobre criterios de eficiencia y eficacia de la gestión, sino también y lo más importante aún, sustentada sobre criterios que garantizan la máxima calidad y seguridad del paciente.

Como ya hemos mencionado, nos pondremos a disposición de las instituciones interesadas para desarrollar, entregar y evaluar la Red Mundial para el diagnóstico médico, incluyendo:

  • Los requerimientos básicos de funcionamiento
  • La operatividad del sistema y los detalles técnicos de los flujos de datos
  • Las normas de identificación y registro de usuarios
  • La normativa de accesos y usos
  • Las diferentes estrategias previstas
  • El plan de actividades
  • El detalle las distintas intervenciones
  • El calendario de operaciones durante el primer año
  • Los modelos de evaluación y los indicadores de resultados
  • Presupuesto inicial, viabilidad financiera y el plan de sostenibilidad económica

JUSTIFICACIÓN

Según reconoce la OMS “en esta primera década del siglo XXI, enormes avances en el bienestar humano coexisten con privaciones extremas. En la salud mundial somos testigos de los beneficios que están aportando los nuevos medicamentos, tecnologías y conocimientos científicos, pero algunos de los países más pobres están sufriendo reveses sin precedentes. Esta creciente polarización en salud, ha llevado a que en algunas zonas del planeta, la esperanza de vida haya caído a la mitad respecto a los países más ricos”. Además reconoce que para avanzar en la lucha contra las desigualdades en salud, sería preciso que los interesados trabajen juntos mediante alianzas y redes – locales, nacionales y mundiales – abiertas a los diversos problemas sanitarios, profesiones, disciplinas, y países. Las estructuras cooperativas pueden mancomunar los limitados recursos económicos e intelectuales y fomentar la enseñanza recíproca.

El Informe Mundial de la Salud 2006 y la Estrategia Regional de Recursos Humanos para la Salud, 2006-2015; han cifrado una escasez mundial de 4,3 millones de trabajadores de la salud. Además, en las estadísticas mundiales de la Seguridad Social 2010/2011 (World Social Security Statistics 2010/2011) se afirmó que en la actualidad hay 100 países con una densidad de profesionales cualificados de la salud por debajo del umbral adecuado, traduciéndose en una escasez total de alrededor de 7,2 millones de profesionales sanitarios y que aumentarán a 12,9 millones en 2035 según unas las proyecciones sostenidas el crecimiento de la población. De modo que podemos afirmar que la escasez de personal sanitario especializado en el año 2015 es peor que en 2006 y es poco probable que esta tendencia se revierta en los próximos años. La idea de nuestro proyecto se basa en la necesidad de trabajar de inmediato para intentar reducir gradualmente las desigualdades sanitarias existentes en la actualidad. Especialmente en intentar reducir aquellas desigualdades relacionadas con el desigual acceso a los conocimientos médicos altamente especializados y que sufren las personas más pobres y las poblaciones más desfavorecidas donde la mayoría de ellos viven en las regiones más pobres del planeta y en los países con escasos recursos económicos y humanos.

Todos aquellos expertos de la gestión sanitaria que conocen en profundidad el funcionamiento de los más avanzados Sistemas Nacionales de Salud (SNS) y sus respectivos servicios sanitarios (Canadá, España, Inglaterra, Suecia…) saben que uno de los problemas más comunes y complejos de la gestión sanitaria es el derivado por la gran demanda y el alto costo de la interconsulta externa generada por la atención primaria hacia la atención especializada. A ello se le añade el problema de los largos tiempos de espera existentes para las consultas iniciales generados por la alta demanda lo que por otra parte genera evidentes desigualdades en el acceso a los conocimientos médicos especializados entre las diferentes regiones. Este gran volumen de demanda de interconsultas externas en la atención especializada, no es caprichosa y en parte, se basa en la alta especialización de la medicina y la amplia fragmentación del conocimiento médico (Sólo sé que no sé nada; Sócrates). Si esto está sucediendo en los servicios de salud más avanzados del mundo en donde la población sufre ciertas desigualdades de acceso a los conocimientos médicos especializados en función de su zona de residencia, que es lo que está sucediendo en las regiones y países más pobres del planeta? Sin entrar en detalles, me imagino que la mayoría de expertos estarían de acuerdo en afirmar que la mayoría de estas personas no tienen acceso adecuado a la medicina especializada. Por otra parte, se podría presuponer que la mayoría de los médicos que trabajan en estos países carecen del apoyo esencial y necesario de otros médicos especialistas, lo que realmente es grave y repercute negativamente en la salud de los pacientes. Las razones son varias y bien conocidas por todos nosotros; la ausencia de SNS, la escasez de recursos económicos, la falta de personal médico especializado…etc.

Por lo tanto, de los múltiples factores determinantes de las desigualdades en salud, nuestro proyecto, aunque sea parcialmente, podría responder con eficiencia y eficacia a dos de los principales factores:

  1. La escasez de personal sanitario cualificado o la escasez de médicos especialistas: esa escasez tiene carácter mundial, pero reviste especial gravedad en los países más pobres donde más los necesitan “Informe Mundial de la Salud 2006”.
  2. La inequidad de acceso a personal médico especializado motivada por razones económicas: La atención sanitaria es una industria de servicios basada fundamentalmente en el capital humano, donde una fuerza de trabajo cualificada, elemento clave de todos los sistemas sanitarios, es fundamental para hacer progresar la salud. Existen evidencias científicas y abundantes pruebas de que el número, la calidad y la densidad de distribución de los trabajadores sanitarios están efectivamente relacionados con la cobertura de inmunización, la supervivencia de los lactantes, los niños y las madres así como con resultados positivos en el ámbito de las enfermedades cardiovasculares, infecciosas y demás problemas de salud.

SOLIDARIDAD Y ALIANZA MUNDIAL DE LOS INTERESADOS COMO FUNDAMENTOS

En palabras del propio Informe Mundial de Salud 2006 – Colaboremos por la salud, por bien concebidas que estén, las estrategias nacionales no bastan por sí solas para hacer frente a la realidad de los desafíos que plantea y planteará la escasez del personal sanitario. Están igualmente condicionadas en unos países y otros por el carácter fragmentario de las pruebas, lo limitado de los instrumentos de planificación y la escasez de conocimientos técnicos especializados. Por tanto, el presente proyecto se plantea, dentro del marco de la cooperación internacional, como un esfuerzo solidario entre la comunidad médica mundial que complemente los liderazgos nacionales, por lo menos en cinco frentes:

  1. Mejorar la inequidad de acceso a personal médico especializado.
  2. Catalizar y difundir el conocimiento médico, las competencias técnicas y las prácticas sanitarias óptimas. La mancomunación eficaz del conocimiento médico especializado y de las diversas competencias técnicas y el amplio abanico de experiencias pueden ayudar a los países a tener acceso a conocimientos profesionales más avanzados y a prácticas más óptimas para mejorar la salud de sus poblaciones.
    Fomentar la enseñanza recíproca y el aprendizaje mutuo.
  3. Alcanzar acuerdos de cooperación sociosanitarios.
  4. Responder a la crisis por la escasez de personal sanitario especializado. Esta crisis en los países más pobres es de una importancia innegable y exige una respuesta urgente, sostenida y coordinada por parte de la comunidad internacional. Todos los asociados deben analizar críticamente por qué medios apoyan a éste, con miras a eliminar las prácticas poco eficientes y coordinar más eficazmente sus acciones con las autoridades nacionales competentes.

Apoyamos la idea de que el liderazgo nacional y la solidaridad mundial pueden y deben lograr importantes mejoras estructurales de la fuerza de trabajo en todos los países, y en especial en los que padecen crisis más graves. Estos avances se caracterizarían por el acceso universal a un personal sanitario motivado, competente y bien respaldado por otros compañeros altamente cualificados.

De ahí nuestra propuesta de construir un sistema de información clínica para apoyar y facilitar el diagnóstico y tratamiento médicos en todo el mundo. A nuestro entender, el proyecto planteado, ayudará de forma efectiva a lograr mejoras de la fuerza de trabajo sanitario en los países que más padecen la escasez de estos recursos y propiciará una mejora inmediata de la atención sanitaria mediante el apoyo técnico especializado que contribuirá a conseguir una mejora en la salud de las poblaciones atendidas.

Nuestra propuesta se basa en la idea de la solidaridad global que ilustra la siguiente figura de cómo podría crearse una alianza mundial de la fuerza de trabajo en salud y que impulse a las partes interesadas a acelerar la lucha contra las desigualdades en salud.

The World Health Report 2006: Figure 5 Global stakeholder alliance

figure 5 global stakeholder alliance

OBJETIVOS DEL PROYECTO E IMPACTO EN SALUD 

OBJECTIVO GENERAL / OBJECTIVO ESTRATEGICO

El presente proyecto tiene por objeto contribuir a la reducción de las desigualdades en materia de salud en especial las desigualdades de acceso que sufren las poblaciones más desfavorecidas. Se trata principalmente de reducir aquellas desigualdades generadas por el limitado acceso al conocimiento médico especializado y por el desigual acceso a personal sanitario altamente especializado.

Por lo tanto, el objetivo general sería fortalecer, apoyar y mejorar la capacidad técnica del personal sanitario de todo el mundo en especial de los países con recursos limitados. Se trata de proporcionarles una forma sencilla de solicitar una ayuda para apoyar el diagnóstico y tratamiento a través de una interconsulta dirigido al personal cooperante de la atención especializada que está asociado a la Red Mundial para el diagnóstico médico. De esta manera pueden mejorar su respuesta a los desafíos sanitarios habituales o emergentes que afrontan en sus labores diarias.

OBJETIVO ESPECÍFICO

El propósito específico sería construir una red médica basada en la innovación tecnológica y cuya finalidad sería la de lograr una alianza mundial de profesionales sanitarios, donde los trabajadores de los servicios públicos de salud de los países con recursos limitados, principalmente aquellos que desarrollan su labor en áreas rurales, suburbios o zonas alejadas, puedan tener de inmediato un apoyo médico especializado que de otra manera no obtendrían. Esto conduce necesariamente a mejorar la salud de la población atendida que de otra manera sería más difícil de lograr.

OBJETIVO SECUNDARIOS

  1. Catalizar, facilitar y difundir la experiencia médica especializada y las mejores prácticas en salud.
  2. Promover el conocimiento médico recíproco y el aprendizaje mutuo.
  3. Contribuir a la difusión del conocimiento médico basado en la evidencia y hacerlo accesible a las poblaciones más pobres y a las regiones más remotas.
  4. Contribuir a proporcionar un apoyo técnico sólido y a una mejor gestión y difusión del conocimiento científico.
  5. Mejorar la capacidad técnica de los médicos y demás trabajadores sanitarios de los servicios públicos de salud de los países con recursos limitados. Esta mejora en la capacitación técnica médica, conduce necesariamente a mejorar la salud de la población atendida.
  6. Mejorar las capacidades técnicas de los médicos de los países desarrollados en áreas específicas, tales como las enfermedades tropicales y emergentes. Esta mejora en la capacitación técnica médica, conduce necesariamente a mejorar la salud de la población atendida.
  7. Mejorar la confianza de las poblaciones en los servicios públicos de salud de sus respectivos países.
  8. Actuar como una plataforma dinámica, confidencial y segura que facilite una rápida comunicación entre profesionales sanitarios de distintos países.
  9. Constituirse en un sistema complementario de alerta para mejorar la detección geográfica de las necesidades médicas más acuciantes con la finalidad de mejorar la efectividad de las respuestas de cooperación sanitaria.
  10. Constituirse en una plataforma de apoyo a las redes existentes de alertas en Salud Pública y Epidemiología para todo el mundo (red auxiliar de vigilancia epidemiológica).
  11. Contribuir a la promoción de las políticas sanitarias saludables.
  12. Contribuir a mejorar la eficacia y la productividad de los SNS y de los respectivos servicios sanitarios de los países cooperantes.
  13. Contribuir al desarrollo tecnológico de las regiones más desfavorecidas. Mediante los acuerdos de cooperación, tanto con los países donantes como con los gobiernos de los países receptores, y como respuesta a la posible ausencia de recursos informáticos en determinadas regiones, se fomentaría:
  • Equipar con terminales informáticas a los centros de salud o puntos sanitarios en las regiones carentes de ellas.
  • El establecimiento de conexiones a la red, especialmente vía satélite.
  • Implantación de generadores de energías limpias; paneles solares, aerogeneradores…etc.
  1. Contribuir al desarrollo económico de las regiones desfavorecidas. Las actividades antes enumeradas, fomentarían la creación de empleos verdes y de alta tecnología.
  2. Aspirar, en un futuro no muy lejano, a convertirse en una plataforma médica de base tecnológica que, mediante el establecimiento de videoconferencia o conferencias de audio, los profesionales cualificados pueden prestar apoyo directo a trabajadores de salud menos calificados para dar respuestas inmediatas a situaciones de emergencia (nacimientos, fracturas, cirugía, … etc.)
  3. Convertirse en la plataforma de comunicación entre el personal sanitario a nivel internacional con todos los beneficios que ello conlleva:
  • Facilitar la difusión de los comunicados de la OMS y las demás instituciones internacionales relacionadas con la salud.
  • Facilitar la libre difusión de las publicaciones médicas y los resultados de la investigación en salud.
  1. Otros beneficios.

POBLACIÓN DIANA

Las poblaciones de los países con recursos limitados cuyos servicios sanitarios públicos padecen una profunda escasez de personal sanitario cualificado. Aunque el beneficio final podría llegar a toda la población mundial.

ÁMBITO Y PARTICIPANTES

Los profesionales sanitarios (especialista médicos, matronas,…) “todas las personas que participan en las acciones cuya intención principal es mejorar la salud” (OMS – IMS 2006) que a través de la red proporcionarán una consultoría clínica especializada y prestarán un apoyo técnico cualificado a los profesionales de los servicios sanitarios públicos de los países con limitados recursos y de las regiones más pobres del planeta.

VENTAJAS E INCONVENIENTES

Al igual que cualquier otro, este proyecto presenta fortalezas y debilidades. De entre sus ventajas, se destaca la utilidad del mismo para contribuir a reducir las desigualdades de acceso en salud. De entre sus desventajas, se destaca la probabilidad de que muchos centros de salud carezcan de las terminales informáticas necesarias o que puedan tener dificultades de acceso a la red, aunque ello podría ser una oportunidad de ir ampliando el alcance de las nuevas tecnologías a las regiones en desarrollo. En la siguiente tabla, se resumen las ventajas y los inconvenientes del proyecto propuesto.

VENTAJAS INCONVENIENTES
1.       Útil2.       Solidario e igualitario3.       Oportuno4.       Asequible, seguro y confidencial5.       Universal

6.       Eficiente y eficaz

7.       Transparente

8.       Consistente y fiable

9.       Práctico y duradero en el tiempo

10.    Simple y fácil de usar

11.    Rápido

12.    Objetivo

13.    Flexible y fácilmente adaptable

14.    Actualizable

15.    Ausencia de incentivos perversos

16.    El acceso limitado a la red de los trabajadores de la salud de algunos países con recursos limitados17.    La financiación inicial18.    La dependencia inicial de la voluntad política

Cabe destacar que nuestra intención es transformar los posibles inconvenientes antes mencionado en oportunidades reales de mejora como ya hemos mencionado en el punto 13 de los objetivos secundarios. Estas actividades promoverán la creación de empleos verdes y de alta tecnología en las regiones que realmente los necesitan. Por otro lado, con la implementación de este proyecto, las circunstancias y las posibilidades de cooperar proporcionando apoyo médico especializado será más fácil, sencillo, cómodo y rápido al no tener que viajar muy lejos, donde el profesional colaborador podrá cooperar en cualquier momento y desde cualquier lugar.

SEGURIDAD JURÍDICA Y RESPONSABILIDADES LEGALES

Cabe destacar que nuestra intención es transformar los posibles inconvenientes antes mencionado en oportunidades reales de mejora como ya hemos mencionado en el punto 13 de los objetivos secundarios. Estas actividades promoverán la creación de empleos verdes y de alta tecnología en las regiones que realmente los necesitan. Por otro lado, con la implementación de este proyecto, las circunstancias y las posibilidades de cooperar proporcionando apoyo médico especializado será más fácil, sencillo, cómodo y rápido al no tener que viajar muy lejos, donde el profesional colaborador podrá cooperar en cualquier momento y desde cualquier lugar.

Al ser este un proyecto de consultoría médica por red telemática, los profesionales sanitarios cooperantes ejercerían de simples consultores sin ninguna capacidad decisoria final sobre el paciente, por lo que estarán eximidos de cualquier responsabilidad legal o jurídica vinculante. Los profesionales sanitarios demandantes del apoyo técnico, son y serán los únicos responsables legales de sus propios actos, por lo que tomarán sus decisiones de forma autónoma con independencia de la opinión de los consultores cooperantes.

SOLIDEZ DEL PROYECTO

DIFERENCIACION DE LAS PRACTICAS EXISTENTES Y PERTINENCIA DE LA ACCION:

El proyecto se basa en una idea innovadora en materia de cooperación; cuya finalidad sería la de rentabilizar más y mejor los inmensos recursos tecnológicos, informáticos y humanos disponibles para proporcionar apoyo médico especializado y soporte sanitario cualificado a los profesionales de los servicios sanitarios públicos de todo el mundo, principalmente a aquellos que trabajan en países con recursos limitados y en las regiones pobres, de una forma sencilla y segura, sin incurrir en ningún coste adicional para las arcas públicas. El uso de la red y la cooperación voluntaria brindarán a las personas más desfavorecidas la oportunidad de acceder a los conocimientos médicos especializados que de otro modo y, por el momento, no les sería posible acceder con todo lo que ello supondría para la mejora de salud y lo que podría significar en la lucha contra las desigualdades en salud. Pensamos que la labor de sensibilización encaminada a situar y mantener la necesidad de cooperación y participación voluntaria del personal sanitario de los servicios sanitarios avanzados en un lugar destacado de su agenda diaria, no resultaría un desafío complicado. La mayoría de estos profesionales tendrían la oportunidad de prestar ayuda a los pueblos más necesitados en cualquier momento y desde cualquier lugar, sin que para ello tengan que desplazarse del sillón de su casa o de su puesto de trabajo.

EFECTIVIDAD Y VIABILIDAD DE LA ACCION:

La claridad del plan de actividades que propondremos y la factibilidad de su aplicación, nos invitan a ser optimistas acerca de la viabilidad del proyecto. Como se podrá comprobar en el plan, cada objetivo estratégico se acompaña de varios objetivos operativos. El cumplimiento de los objetivos operativos planteados se garantizará mediante la implementación de una serie de actividades y prácticas acordes a la consecución de los mismos donde, cada actividad cuenta con un responsable y un tiempo máximo para su ejecución, pudiendo ser las mismas objetivamente verificables al finalizar el periodo de fijado para su consecución. De este modo, los indicadores del resultado de cada acción deberán verificar objetivamente el logro de los objetivos y su grado de implementación.

IMPACTO ESTRUCTURAL DESEADO Y SOSTENIBILIDAD DE LA ACCION:

En el plan de actividades se detallarán los efectos multiplicadores en materia de salud que va a lograr la implementación y puesta en marcha de la red. El lanzamiento mundial del proyecto tendría que reproducir las actuaciones efectivas del periodo piloto procurando aplicar aquellas medidas que más éxitos hayan tenido en esta primera fase. De modo que, mediante la implantación del presente proyecto, y reconociendo que parte de las siguientes aspiraciones se fundamentan en la inmensa ilusión depositada en el mismo, en los próximos 5 a 10 años desde su implantación se aspira a obtener los siguientes efectos tangibles:

  • Responder a más de cinco millones de interconsultas médicas especializadas que de otro modo no podrían haber ocurrido.
  • Establecer más de 3 millones de planes de cuidados de enfermería.
  • Establecer más de 1 millón de planes de cuidados sociosanitarios y de salud mental.
  • Haber contribuido a mejorar la calidad de la atención sanitaria en todo el mundo.
  • Haberse constituido en la plataforma de comunicación profesional de referencia entre los profesionales de salud a nivel mundial.
  • Haberse contribuido a catalizar y difundir el conocimiento médico, las competencias técnicas, el conocimiento científico y las prácticas sanitarias más óptimas.
  • Haberse contribuido a la mejora de la detección geográfica de las necesidades sanitarias más acuciantes en las distintitas regiones del planeta.
  • Haber difundido más de 100.000 artículos, notas o comunicaciones científicas relacionadas con la promoción de las políticas públicas sociosanitarias más saludables.
  • Haber contribuido a la introducción e implantación de más de 50.000 terminales informáticas en los centros de salud de las regiones más pobres, haber contribuido a conectarse a la red de más de 5.000 regiones aisladas y de haber contribuido a la implantación de más de 500 nuevos generadores de energía limpia en regiones carentes de ella.
  • Otros impactos.

SOSTENIBILIDAD DE LOS RESULTADOS PREVISTOS DERIVADOS DE LAS ACTIVIDADES PROPUESTAS:

Más adelante pondremos a disposición de la institución interesada los planes que detallan la sostenibilidad económica del proyecto y los planes que garanticen la financiación futura de las actividades. Por otra parte, cabe destacar que la sostenibilidad institucional del proyecto quedaría garantizada por la acción continuada que se llevaría a cabo tal y como se detallará en el plan de actividades. Las infraestructuras establecidas, los acuerdos alcanzados, la implicación activa de los distintos actores y los efectos positivos cosechados garantizarán el funcionamiento futuro de la red con independencia de las voluntades personales. Finalmente destacar los impactos positivos que se tendrían por la aplicación del proyecto en lo que respecta a las políticas sociosanitarias y medioambientales y a las que antes nos hemos referido.

CONCLUSIÓN

OMS “No hay atajos y no hay tiempo que perder. Ahora es el momento de actuar, de invertir en el futuro, y para promover la salud rápidamente y de manera equitativa”

No hay soluciones fáciles y no hay consenso en cuanto a la forma de actuar. Sin embargo, todos sabemos que el factor humano es esencial para fortalecer los sistemas de salud y mejorar las posibilidades de supervivencia de las personas y su bienestar. Esto significa que tendríamos que invertir mucho tiempo y dinero en la formación de los trabajadores sanitarios, por lo que creemos que este proyecto ayudará a lograr estos objetivos e intentará responder de alguna manera a ese problema facilitando la capacitación de los profesionales sanitarios con ahorro de tiempo y dinero contribuyendo así a la solución del mismo.

La comunidad internacional (OMS, UNAIDS, BANCO MUNDIAL, Organización para la Cooperación Económica y el Desarrollo,…) cuenta con los recursos económicos suficientes para intentar hacer frente a una buena parte de estos desafíos sanitarios. También sabemos que lo que se necesitaría es una voluntad política para poner en marcha nuevas medidas de cooperación internacional con el fin de coordinar los recursos, aprovechar los conocimientos y prestar apoyo para desarrollar sistemas sanitarios robustos que traten y prevengan las enfermedades y promuevan la salud de la población principalmente en aquellos países que carecen de los recursos suficientes. Estamos seguros de que este proyecto contribuirá a la consecución de los objetivos antes mencionados y a la mejora y protección de la salud en todo el mundo, pero ello no sería posible sin el apoyo directo y sincero de la OMS y/o de otras instituciones sanitarias internacionales con una clara apuesta por la innovación sanitaria como una herramienta segura para mejorar y hacer progresar la salud de la población mundial.

Creemos que todos los esfuerzos para reducir las desigualdades en salud son dignos de ser estudiados y evaluados por lo que pensamos que vale la pena apostar por la creación, desarrollo, implantación y promoción de la Red Mundial para el Diagnóstico Médico que proponemos en esta publicación como una nueva e innovadora herramienta sanitaria que contribuirá a la lucha contra las desigualdades en salud y reducirá la inequidad de accesos al conocimiento médico especializado.

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  33. Edward J. Mills, William A. Schabas, et al., “Should Active Recruitment of Health Workers from Sub-Saharan Africa Be Viewed as a Crime?” The Lancet 371, no. 9613 (2008): 685 – 88; World Health Organization, Global Atlas of the Health Workforce, March 2008. Available at: http://www.who.int/globalatlas/default.asp
  34. Naicker SPlange-Rhule JTutt RCEastwood JB. Shortage of healthcare workers in developing countries–Africa. Ethn Dis. 2009 Spring;19(1 Suppl 1):S1-60-4. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19484878
  35. Glob Health Action 2014, 7: 23611 – http://www.globalhealthaction.net/index.php/gha/article/view/23611

 

*Bashir Saiegh Saiegh Doctor Suma Cum Laude en Medicina y Salud Pública, Especialista en Salud Pública, Epidemiología y Medicina Preventiva, Especialista en Sistemas Clínicos de Información y Especialista en Gestión Sanitaria. Experto en: Sistemas Nacionales de Salud, Políticas de Salud Pública, Políticas de Salud Global y en  Políticas Sanitarias. Fundador y CEO de Tulaitula Health Consulting Group.

Tulaitula Health Consulting Group, todos los derechos reservados. Este proyecto ha sido desarrollado y enviado para contribuir a mejorar las políticas de acceso equitativo a la salud. El autor ha tomado todas las precauciones posibles y ha verificado toda la información contenida en esta publicación. Las solicitudes de autorización para reproducir o traducir esta publicación, así como para cualquier otra información relacionada con el contenido del proyecto deberán dirigirse al correo electrónico: manager@tulaitula.com

Agradecimientos: mi gratitud al Dr. Daniele Dionisio por su interés y por la oportunidad que me ha dado para colaborar y tratar de contribuir a las políticas para el acceso equitativo a la salud “Policies for Equitable Access to Health”. Así mismo hago constar mis agradecimientos a todas las personas que están trabajando y contribuyendo a la reducción de las desigualdades en salud en todo el mundo, incluidos los miembros del “EP Working Group on Innovation, Access to Medicines and Poverty-Related Diseases”.

 

Breaking News: Link 163

Breaking News Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

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