Healthcare in Indonesia
The COVID-19 pandemic drew attention to the spread of airborne diseases and the vulnerability of the human population, but in everyday lives, another form of disease continues to haunt humans. These are non-communicable diseases (NCDs), which are typically long-lasting and do not have a specific cause. The most common NCDs are cardiovascular and respiratory diseases, cancer and diabetes. The cause of death for individuals around the globe remains NCDs in 71% of all cases, an alarming statistic that becomes more apparent considering most of these deaths are premature. Of those dying from NCDs, 85% are located in “low- and middle-income countries.” The prevalence of these types of diseases in Indonesia and other countries harms specifically those living in poverty. Among numerous other challenges in their daily lives, people do not have the resources for medical treatment or must utilize all of their remaining resources for treatments. The prevention of NCDs prevails as an important policy goal to implement in the fight against decreasing the number of deaths associated with NCDs and reducing poverty.

Non-Communicable Diseases in Indonesia

Located in Southeast Asia and consisting of numerous islands, Indonesia boasts a tropical climate. Indonesia is one of the most populous countries in the world, behind China, India and the United States. The demographics of the population are young with 42% under the age of 25. About 10% of the population lives in poverty.

With the COVID-19 pandemic bringing into focus some of the pre-existing health conditions that remain health risks when contracting the virus, it is important to address the concerns of high rates of NCDs and improve health care in Indonesia. According to the World Bank, NCDs caused 76% of deaths in Indonesia in 2019, a number that continues to rise over time. This is above the rate of 71% of deaths that NCDs have caused in the world, meaning that people must pay close attention to the risks of NCDs within this population.

Project Hope

In 1958, a Navy veteran, Dr. William B. Walsh founded an organization called Project Hope. His service in World War II inspired him to address health concerns that he encountered during wartime. The organization’s work started on a restored ship called SS Hope which delivered healthcare around the world, especially during the Cold War. Now, Project Hope operates by training the local medical community of volunteers in more than 20 countries. Over its 60 years of service, the organization trained more than 2 million individuals and delivered $2 billion in resources to communities in need.

To respond to the problem of NCDs in Indonesia, Project Hope assists with diagnosis and education about the issue, even utilizing remote training during the COVID-19 pandemic with a partnership with Brown University. The organization works especially hard on the ability to diagnose patients because it predicts many cases of NCDs remain undiagnosed. This realization is relevant because it assists in knowing how to respond and treat diseases within the population, the ability to prevent certain diseases and asserting control over diseases rather than simply reacting to emergencies involving one’s NCD. The organization educates doctors on diabetes and delves into issues related to asthma by training medical professionals and providing information on the detention of asthma. Project Hope helped more than 11,000 people seek treatment for their diseases, transforming the field of health care in Indonesia.

Project Hope’s Larger Impact

Apart from its work in NCDs, Project Hope also assists in other areas of health care in Indonesia. The organization works to address the deaths of mothers and infants, which largely occur in live births and due to malnutrition, respectively. Through health programs for mothers and children and “monthly wellness clinics,” local communities work together to address maternal and child health. Similarly, Project Hope responds to disasters within the region. For example, after the tsunami in Sulawesi in 2018, Project Hope assisted in providing insecticide to prevent malaria, providing water through new purification systems and checking for NCDs in the population.

The range of work that Project Hope completes in health care in Indonesia is broad but equally important. Through its main project of addressing NCDs in the region, improving maternal and child care and emergency response, the organization continues to make a large impact on the region after more than 60 years.

– Kaylee Messick
Photo: Flickr

Oceania's Health ChallengesRecent genetic studies of Pacific Islanders are revealing new insights into Oceania’s health challenges. In turn, these insights may drive sustainable solutions that improve community health and save lives.

Convenience-food diets, obesity, lack of resources and the health challenges that result from these conditions are escalating in many island nations in the Pacific. Worse, the resulting non-communicable diseases (NCDs) are leading to an increase in preventable deaths. Activists from many nations are working to better protect many Pacific Island populations from Oceania’s health challenges.

Oceania

Oceania is a group of countries and territories that share a border with the Pacific Ocean. These 14 countries and territories are diverse culturally, economically, geographically and demographically. Oceania includes the large and wealthy countries of Australia and New Zealand and smaller and less affluent countries including Figi, Tonga and Palau.

Vulnerability

Indigenous people in Oceania are more genetically prone to gut issues and certain NCDs that evolved during colonization. While traditionally, Oceania diets were low-energy-density, the introduction of processed foods and more modern snacks brought obesity and linking issues. Before colonization, there was little to no obesity in the Pacific Islands. According to a 2019 study published in Frontiers in Immunology, “During the period of nutritional transition, the people came to consume energy-dense foods imported from Australia and New Zealand.”

The study reports that certain health conditions disproportionately affect specific indigenous populations including the Polynesians in Hawaii, the Maoris in New Zealand, and the Aboriginal and Torres Straits Islanders in Australia compared to non-indigenous people in the same places.  Mortality rates, NCDs and fertility decline are all issues that disproportionately affect these populations. Studying Pacific Islanders’ health data more closely, as this study did, may lead to sustainable solutions.

Environmental factors such as urbanization, sanitation and pathogen exposure also have the potential to increase disease susceptibility. Genetic vulnerability in the form of microbiome genetic mutations and immune function justifies population-specific medical studies and consideration in regards to nutrition. Accessibility and food insecurity have also driven people to foods that are low in nutrition.

Solutions

There are several specific solutions to combat the sharp rise in NCDs in the Pacific Islands. One strategy is better health monitoring. Current medical data surrounding nutrition is almost nonexistent and therefore Pacific Islander nutrition lacks proper evaluation. Increasing data and enhancing research in this area can better inform people about their eating habits.

The George Institute for Global Health, Fiji National University, Sydney University and Deakin University have created the Global Alliance for Chronic Diseases project. This effort hopes to collect data on preventable deaths and possible food policy initiatives for the future. The researchers already found that decreasing salt intake by one gram a day for a year would prevent heart attacks and strokes and save 131 lives a year.

A second strategy is creating a sustainable interest and consumer demand for fresh and healthy foods.  Since COVID-19, Fiji’s Ministry of Agriculture has distributed seeds for people to grow their own food at home. Additional countries could benefit from a program like this as well.

Other strategies include projects and policies that focus on building a stronger market for healthy foods. Finally, the study suggests applying a gender lens to improve Oceania’s health challenges.  While more women are joining the workforce, they continue to play the primary role in caring for and feeding their families.  They do not have the time to prepare complicated meals so they are turning to convenience foods.

World Bank Showcases Oceania Women Leaders

The 2019 genetic study, others like it and the projects mentioned above are setting a trend of focus on the nutritional health of Pacific Islanders. Sustainable change and progress are occurring throughout Oceania. This progress prompted the World Bank to showcase some inspiring women who are starting to implement solutions to Oceania’s health challenges. In Samoa, Lenara Tupa’i-Fui is the assistant CEO of Health Information Technology and Communications at the Somoa Ministry of Health. She is helping lead the Samoan eHealth system that will better track medical records and provide accessible health monitoring and data. As program director of the Partnership of Human Development in Timor-Leste, Armandian Gusmão Amaral advocates for better health care, especially for women and children. She also focuses on mentoring women to pursue careers in the medical profession.

Looking Ahead

Advocating for better data tracking and health communication, increasing the understanding of and demand for healthy foods and applying a gender lens to improving eating habits are all steps that are helping the vulnerable in Oceania take action on their health.

– Karen Krosky
Photo: Flickr

non-communicable diseases in El SalvadorEl Salvador has experienced rampant public health problems for generations and has recently made commendable successes in addressing these problems. However, non-communicable diseases in El Salvador continue to be stubborn roadblocks that cost many citizens their health and their lives.

Non-Communicable Diseases (NCDs) in El Salvador

Non-communicable diseases are those that cannot be directly spread from one person to another such as Alzheimer’s, cancer and diabetes. Like the rest of the world, NCDs are a leading cause of early death among the adult population in El Salvador. Estimates show about 71% of all global deaths result from NCDs, the majority of which come from low-and middle-income countries. During the 2011–2015 period, in El Salvador, one of the most impoverished and most dangerous countries in Latin America, cardiovascular disease accounted for some 12% of deaths. Chronic kidney disease followed at 6.3% and cancer at 5.4%.

Many of the factors leading to high death rates from non-communicable diseases in El Salvador are lifestyle-related. Sedentary lifestyles, smoking and poor nutritional choices all contribute to NCDs such as diabetes and cardiovascular disease. Poor nutrition is common in many low-and middle-income countries. A health survey among El Salvadorians found almost 94% of citizens consumed too few fruits and vegetables and almost as many consumed an excess of sugary beverages. With this information, it is no surprise the survey also found relatively high rates of overweight and obese adults. Obesity is synonymous with NCDs. Furthermore, chronic kidney disease is particularly prevalent among El Salvadorian adults. This results from excessive use of anti-inflammatory medication, inadequate hydration and exposure to agrochemicals in the workplace.

Previous Healthcare Efforts

Public health problems are nothing new to El Salvador. The Ministry of Health has been ramping up efforts to address these problems since 2009. Some of the main concerns in the past have been the fragmentation of the health sector and high rates of uninsured citizens. In 2009, the Ministry of Health implemented a National Health Strategy to correct these issues. Throughout this program, increasing equity of access to health services, improving the quality of these services and strengthening the monitoring and oversight capacity of the Ministry of Health have been top priorities. In order to accomplish these goals, El Salvador increased its public health expenditure by 33.7% from 2009 to 2019. The country also increased the amount of these expenditures allocated to the public health sector by 8%.

Many of these efforts have paid off, albeit modestly. Because of the National Health Strategy, more public health services have reached impoverished and remote citizens in El Salvador. Expanding access to healthcare has had a positive effect on the country’s economic outlook. The income-poverty rate decreased from 46.4% in 2008 to less than 34.8% in 2013 and extreme poverty dropped from 15.4% to 9.1% in the same period. Furthermore, El Salvador’s Gini coefficient (measure of income inequality) decreased from 0.47 in 2009 to 0.41 in 2013, in large part due to public service equity efforts such as those executed by the Ministry of Health.

Non-Communicable Disease Efforts

Even with all this progress, the problem of non-communicable diseases in El Salvador remains. Non-communicable diseases account for more than 65% of all deaths in the country. Therefore, the Ministry of Health teamed up with the World Bank and Access Accelerated in 2018. The two wanted to specifically fight NCDs through the project El Salvador Addressing Non-Communicable Diseases. This project focuses specifically on improving the prevention, detection and treatment of cervical cancer as well as the prevention of common NCD risk factors. In fighting cervical cancer, El Salvador received more than 86,000 HPV screening tests and almost 30,000 doses of HPV vaccines. Both prevent cervical cancer by taking early action.

Besides cervical cancer, the program works to fight other non-communicable diseases in El Salvador. It accomplishes this by training healthcare workers, providing workshops on nutrition and expanding access to mental health resources. The arrival of COVID-19 has disrupted some of these programs. However, it also forced organizers to rethink how to properly deliver care in continuation of their public health efforts. New methods have included providing health education through social networks, improving the delivery of medication, increasing the use of telehealth and making home dialysis available for chronic kidney disease patients. These approaches to healthcare spurred by COVID-19 will likely live on in the post-pandemic world. Many changes like switching to telehealth are increasingly popular, both in El Salvador and around the world.

The Road Ahead

As in most other nations, non-communicable diseases in El Salvador weigh heavily on the population. However, El Salvador has proven during the past decade that improving access to healthcare for impoverished citizens, treating NCDs proactively through preventative measures and championing new flexible ways of delivering healthcare are positive steps any country can take to make an impact on national public health. Though researchers will not know the full effects of recent programs for some time, early results are promising. Physicians are administering more HPV tests and vaccines, more public health services are reaching low-income citizens and pandemic-era practicalities are proving so popular that they will likely be hallmarks of global healthcare in the years to come.

Calvin Melloh
Photo: Flickr

Non-Communicable Diseases in the Caribbean RegionNon-Communicable Diseases (NCDs) are now causing more damage than communicable diseases, globally killing approximately 40 million persons annually, three-quarters of which occur in low and middle-income countries. Cardiovascular disease, cancer, diabetes, chronic respiratory disease and mental disorders have now been confirmed as the leading causes of death worldwide.

Unfortunately, this reality is no different in the Caribbean. According to the Pan American Journal of Public Health, every year 16,000 persons prematurely succumb to Non-Communicable Diseases in the Caribbean region. In fact, over 70% of all deaths in the region can be traced back to an NCD. Such a record has lasting effects, significantly stunting economic growth and productivity, and has been brought to the alarming attention of health authorities. While the exact reasons for such high mortality rates still remain an ongoing point of research and discussion, risk factors, including tobacco smoking, harmful use of alcohol, poor diet and physical instability, have been found to significantly contribute to the mortality of NCDs in the Caribbean Region. Furthermore, the lack of improvement in the quality of available health care has also been identified as one of the leading causes of the rise in NCD prevalence, case-fatality rate and mortality burden in the Caribbean region.

Investment in Prevention and Control of NCDs

For a long time, regional leaders wrote off deaths associated with NCD as unavoidable. However, the impacts of the NCD epidemic in the region have been found to be much more far-reaching than just health and well-being. Moreover, the existing NCD epidemic has served as a catalyst for negative ripple effects on the economies, productivity and quality of life in the region. Investing in the prevention and control of NCDs is therefore needed to keep other indicators of economic growth and development in check.

Existing Policy Action to Address the NCD Epidemic

Caribbean leaders have put forward outstanding effort and measurements to curb the growing costs associated with NCDs. While sticking with the timeline has proven to be quite a challenge, the regional health authorities have set the following paths and goals toward slowing the progression of its NCD epidemic:

  • The 2007 Mandates of the Port of Spain Declaration (POSD): This includes 27 commitments to action in the areas of reducing NCD risk factors, which include improving healthcare awareness and quality, increasing development of appropriate legislative frameworks and establishing NCD commissions to provide effective monitoring and evaluation of NCD prevention and control efforts.
  • The World Health Organization’s Best Buys/Investments: WHO has designed a set of affordable, cost-effective and evidence-based interventions termed the “WHO Best Buys” to achieve the Sustainable Development Target of 30% reduction of premature NCD related deaths by 2030. Made up of six policy target areas: tobacco use, harmful alcohol use, poor diet, low physical activity, management of cardiovascular diseases and diabetes and cancer management, the regional health authorities have set out to generate a $7 yield in health care costs for every $1 invested in Caribbean health care reform by 2030. Additionally, with 16 areas of targeted intervention to guide the policy decisions of each country in the region, countries can design their health policy to address their specific NCD related challenges.
  • Global WHO 25 x25 Strategy: After the 2007 mandate of the POSD in the Caribbean, the World Health Assembly set a global target of a 25% reduction in NCD related mortality by 2025. Set as a part of the WHO’s Global NCD Action Plan 2013-2020, the WHO detailed a total of nine voluntary national targets, with reduced mortality from NCDs and stopping the rise in diabetes and obesity being among the most urgent. This is set to be done through directed health and public policy, focusing on social, political and economic determinants of NCDs in the Caribbean Region.

With continued health policy effort and focus, both the Caribbean Region and the world at large will be able to successfully control this Non-Communicable Diseases epidemic.

Rebecca Harris
Photo: Flickr

Healthcare in GuyanaThe catalyst for improvement of Guyana’s healthcare system was the HIV/AIDs crisis, which was difficult to manage as a result of the country’s insufficient healthcare system. Since then, however, healthcare in Guyana has improved substantially. Some of the most notable improvements to Guyana’s healthcare system include an increase in life expectancy, increased immunization coverage, increased education and awareness surrounding health issues and decreased infant mortality rates.

“Health Vision 2020”

Healthcare in Guyana is comprised of both a public and a private sector. The Ministry of Public Health leads the public healthcare sector, which functions as a universal healthcare system for all citizens and residents of Guyana. In 2013, the World Health Organization, in combination with Guyanese government agencies and other key stakeholders, created “Health Vision 2020,” a national health strategy enacted to improve the standard of living in Guyana.

Since the strategy’s enactment in 2013, Guyana has seen an impressive decline in the number of reported malaria cases, which once presented an overwhelming threat to the wellbeing of the population. In 2013, there were 31,479 reported cases of malaria. Just two years later in 2015, Guyana minimized the threat of malaria, reporting only 9,984 cases.

Over a slightly longer period of time, Guyana also saw an increase in life expectancy, progressing from 59 years for males in 1992 to 63 years in 2011. In 1992, females were expected to live for 66 years, while in 2011 female life expectancy reached 69 years. Also notable is the improvement made in the number of children receiving an immunization to measles. The percentage of children who received the measles vaccine amounted to 99% in 2012, up from 73% in 1992.

Although the improvements made to Guyana’s healthcare system are commendable, particularly under “Health Vision 2020,” there are still many issues that Guyana’s healthcare system overlooks.

Equitable Healthcare for Hinterland Communities

Though universal healthcare does exist in Guyana, free healthcare facilities and resources are generally catered to reach the majority of the population. Almost 90% of Guyana’s population lives in coastal areas, whereas only about 10% of the population lives in the rural hinterlands. As a result, there is a far greater concentration of healthcare facilities and resources in the coastal areas. Access to healthcare for those living in the hinterlands of Guyana is limited, given that there are few healthcare clinics located outside of coastal areas. Healthcare clinics located in remote areas offer services inferior in quality.

Non-Communicable Diseases

Guyana’s healthcare system has also been unable to curb the effects of non-communicable diseases. In 2012, non-communicable diseases made up the top five leading causes of death in Guyana. Still today, some of the leading causes of deaths in Guyana include ischaemic heart disease and diabetes. In 2015 alone, diabetes was responsible for 9% of the total deaths in Guyana.

Although non-communicable diseases are non-transmissible, it is possible to reduce the number of those with these diseases, particularly through education and awareness. Many non-communicable diseases are caused by high intake levels of alcohol, tobacco, salt, sugar and a lack of physical inactivity. Heightened public awareness of the causes of the most prevalent non-communicable diseases in Guyana would likely reduce the number of those infected.

Healthcare Workforce

While Guyana has managed to recruit more than 500 trained doctors and physicians over the last five years, shortages in the workforce “exist in areas such as registered nurses and nurse midwives, radiographers, medical technologists and social workers.” Part of the problem stems from a lack of incentives for healthcare workers to stay in the public sector and as practitioners in the country. There is also a lack of foreign expertise in the Guyanese healthcare system. Foreign doctors often offer valuable knowledge, especially when dealing with diseases and viruses that might be less common in Guyana.

What Is Being Done?

The Organization for Social and Health Advancement for Guyana and The Caribbean (OSHAG) is a nonprofit organization based in Queens, New York, that demonstrates the possibility for effective solutions to these pressing issues. The organization strives to raise awareness about the need for improved medical services and treatment in Guyana, specifically for cancer patients. OSHAG raises awareness through health education and gatherings of medical professionals with valuable skills to offer to patients in Guyana.

In 2014, OSHAG’s team of medical professionals provided training to nurses within four of the 1o regions that make up Guyana. The team worked to improve the chemotherapy and oncology department at the Guyana Georgetown Public Hospital. Though the organization specifically aims to improve treatment, services and facilities for cancer patients, OSHAG’s impressive leadership and methodology demonstrate what is possible for healthcare in Guyana. With increased awareness, education and foreign interest and investment, healthcare in Guyana can undoubtedly reach new heights.

Though Guyana has made impressive improvements to its healthcare system, there is still room for improvement. Unequal access to healthcare services and facilities, non-communicable diseases and an understaffed healthcare workforce present some of the most pressing problems. However, each of these problems can be addressed through heightened public awareness and education, and increased financial investment and foreign relations.

Stacy Moses
Photo: Flickr