HHS Secretary Leavitt Says "Substantial Resources" Available For Health System

HHS Secretary Mike Leavitt on Tuesday said he is "prepared to bring substantial resources" from his department to rebuild the Louisiana health care system, disrupted by Hurricane Katrina, into "a national model," the New Orleans Times-Picayune reports. Speaking before a joint House-Senate health care committee, Leavitt said, "It would be wrong to rebuild the old system back." Leavitt said a new Louisiana system should focus less on emergency services and more on preventive and primary care. In addition, Leavitt "gave broad hints that he wants the state to move away from" the Charity Hospital system, which before the hurricane received most of the state's federal indigent-care funding, according to the Times-Picayune. Leavitt said the state and the Louisiana Recovery Authority should present a waiver application to him detailing how a reformed health care system would operate (Moller, New Orleans Times-Picayune, 4/26). PriceWaterhouseCoopers this week is releasing a report prepared for LRA which recommends that Louisiana State University, the operator of the Charity system, build a new hospital in downtown New Orleans to replace Charity and University hospitals, which were badly damaged by the hurricane. The report states that the city does not need additional acute-care hospital beds but could use additional hospital space for teaching, advanced specialty care and medical research. If the city repopulates more quickly than expected, those specialty beds could be converted for general use, according to the report. If LRA's health care committee adopts the report, it likely will move to the full board for approval and become the basis for LRA's recommendations to Gov. Kathleen Blanco (D). LSU officials and the Department of Veterans Affairs are negotiating a possible joint venture to build connected hospitals in New Orleans, according to the Times-Picayune (Moller, New Orleans Times-Picayune, 4/25).

Reaction
The Times-Picayune reports that "[a]ny plan to redistribute the federal health care dollars will be controversial, as the Charity Hospital system and other groups with a stake in the current system inevitably will see their roles change as money is distributed." LSU health care spokesperson Marvin McGraw said hospital officials had no comment on Leavitt's testimony or the PriceWaterhouseCoopers report. Blanco said she would not give opinions on plans to redistribute federal money away from the Charity system until a detailed proposal is written. Louisiana Department of Health and Hospitals Secretary Fred Cerise said he plans to convene a committee made up of LRA health care committee members and others to develop a waiver application. Cerise said the application could be ready in three months. State Sen. Tom Schedler (R), who has advocated reforms, said, "There's going to be a lot of resistance, and I think it's going to take someone on the outside with a pen and a dollar bill to change it" (Moller, New Orleans Times-Picayune, 4/26).

City Given Special Designation
In related news, the federal Health Resources and Services Administration on Tuesday declared that New Orleans is a medical shortage area and qualifies for incentives intended to attract more medical personnel. According to data compiled by the state DHH, the city since the hurricane has lost 77% of its primary care doctors, 89% of its psychiatrists and 70% of its dentists. With the federal designation, Medicare reimbursements to New Orleans physicians will increase by 10%, and the city will become an eligible destination for programs that place young doctors in areas with medical shortages in return for payment assistance on their medical school loans. Roberto Quintal, president of the Orleans Parish Medical Society, said that the loss of medical personnel is proportionally greater than the city's overall population loss. "We need to retain our medical work force, and we need to try to attract those who have left as well as new doctors," Quintal said, adding, "This is a way to help them stay here while they rebuild their practices" (Pope, New Orleans Times-Picayune, 4/26).

Private Hospitals Struggle
USA Today on Wednesday examined how Katrina "blew the medically uninsured into the arms of the states' private hospitals, clinics and doctors," but "state and federal funds to pay for their care did not immediately follow." Ochsner Medical Center did not close after Katrina and became a "magnet for post-storm medical emergencies," USA Today reports. In 2005, the hospital registered $70 million in operating losses, 85% of which accrued after the hurricane. Ochsner and the Louisiana Hospital Association say the federal government has provided funding that covers a fraction of their costs and is designated for claims only up to Jan. 31 of this year. Ochsner is operating on a $290 million cash reserve it built from selling its HMO in 2004. Ochsner CEO Pat Quinlan said he has asked for funding from the state, Congress and HHS. "We're being consumed by their slow response, indecision or calculated decision for us to be used up in the process. The kind of losses the major institutions are incurring [are] simply not sustainable." CMS Administrator Mark McClellan said the federal government through June is distributing about $500 million in special Medicaid funding, primarily to Louisiana (Smith, USA Today, 4/26).

Children's Study
In related news, the Times-Picayune on Friday examined a recent Columbia University Mailman School of Public Health report that found more than one-third of children living in temporary housing in the New Orleans area have at least one chronic medical condition, a rate one-third higher than the national average (Pope, New Orleans Times-Picayune, 4/21). The MSPH report is available online. You must have Adobe Reader to view the report.















"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Boston Globe Reports On Internal Investigation Of Global Fund Practices

The Boston Globe on Monday reported on an internal inspector general investigation into the business expense practices of the executive director of the Global Fund To Fight AIDS, Tuberculosis and Malaria. According to the Globe's description of the investigation, which was completed in August 2006, Global Fund Executive Director Richard Feachem has "made extensive use of a little-known private bank account, spending hundreds of thousands of dollars on limousines, expensive meals, boat cruises and other expenses." According to the Globe, a separate investigation by the World Health Organization also "raised concerns" over use of the account. Global Fund spokesperson Jon Liden said, "These expenses are reasonable and necessary for carrying out the business of the Global Fund," adding that the report is of "extraordinarily poor quality in terms of accuracy, context and fairness. We have nothing to hide." (Donnelly, Boston Globe, 2/5) The Global Fund in a release on Monday provided comments and clarifications on a "number of untrue or misleading statements" made in the Globe article (Global Fund release, 2/5).

"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Cameroon To Host WHO Regional Committee For Africa

The fifty-eighth session of the World Health Organization (WHO) Regional Committee for Africa is scheduled to take place from 1 to 5 September in Yaound?©, Cameroon.


This year's meeting of the Regional Committee, WHO's Governing Body in the African Region, will take place in the context of change and reform, initiated by Dr Luis Sambo, since he was elected to the post of Regional Director four years ago.


At the meeting, Dr Sambo will present his biennial report for 2006-2007, highlighting successes achieved and challenges faced in the pursuit of the Organization's mandate of helping to improve the health situation in the 46 Member States of the Region.


High on the agenda of this year's meeting are proposed actions to improve the health of women and curb the harmful alcohol use in the Region; a strategy for cancer prevention and control; a progress report on accelerating HIV prevention and polio eradication, and proposals for eliminating iodine deficiency disorder.


Others agenda items are proposals for strengthening laboratories which are key to disease detection, and suggestions for implementing an Oral Health strategy adopted by Member States in 1998.


During the meeting, panel discussions will be organized at which delegates will share best-practices in reducing maternal mortality; scaling up HIV prevention, treatment and care; improving immunization coverage, and scaling up interventions for malaria prevention and control in the Region.


afro.who.int

Cambodia's HIV/AIDS Fight At Critical Crossroads In Funding, Prevention: New Report

Despite Cambodia's remarkable history in driving down HIV infections, a report released on the future of AIDS in the country argues that future success is not guaranteed and the government needs to focus increasingly on wise prevention tactics and assume more of the financing of its AIDS program.



The report, called The Long-Run Costs and Financing of HIV/AIDS in Cambodia, written by Cambodian experts working closely with staff of the Results for Development Institute (R4D), based in Washington, D.C., finds that Cambodia, in a best-case scenario, could reduce the infections to 1,000 people a year in 2031 - a half-century after AIDS was first identified. That is down from an estimated 2,100 infections last year and from the peak of 15,000 a decade ago.



But the report's authors also say that if Cambodia's AIDS efforts stall and current coverage of key services declines, especially in carefully targeted prevention, the number of infections could climb to 3,800 a year in 2031 - nearly a four-fold increase over the best-case scenario. The report concludes that the government's successful track record will only be maintained if it scales up prevention services for the most at-risk populations, such as sex workers, men having sex with men, and injecting drug users.



"We welcome this in-depth and forward-looking report for our country," said Cambodia's Minister of Health H.E. Dr. Mam Bunheng. "Cambodia has a long history of fighting HIV/AIDS head-on, with effective prevention strategies, and we believe that this report will help us sharpen our strategies. Our goal is to further prevent the number of HIV infections in our country and we will continue on that path."



In Cambodia, HIV/AIDS was first identified in 1991. Only a few years later, experts warned that the epidemic had taken off rapidly and that Cambodia risked becoming the Asian country with the worst AIDS problem. In response, the country attacked the epidemic vigorously, earning international recognition for its success. Between 1998 and last year, Cambodia dramatically reduced new infections and made anti-retroviral treatment widely available. By 2009, an estimated 93 percent of those eligible for AIDS drugs were receiving them.



Still, Cambodia's AIDS epidemic, fueled largely by unprotected heterosexual sex between men and female sex workers, remains volatile and could spread rapidly without targeted prevention efforts, the new report says.



The cost of the national AIDS program also has grown from US$21 million in 2003 to US$51.8 million in 2008, raising some concerns among government and donor officials about their ability to sustain a growing level of spending to fight the epidemic over the years to come. Donors now fund 90 percent of Cambodia's AIDS program.



The report is the third in a series of studies done by the financing group of aids2031, an international initiative that has brought together some of the world's experts on AIDS. The group also issued a report on the global trends in financing the AIDS fight, which was summarized in a paper published earlier this year in The Lancet, and a report on South Africa's epidemic, which was released in mid-November.
















Robert Hecht, managing director of R4D and overall coordinator of the series of reports, said that the Cambodian study has particular significance for countries in Asia, Latin America, and Eastern Europe that are fighting AIDS epidemics largely confined to specific at-risk groups.



"Cambodia is an important example of a country that was facing a possible catastrophe a decade ago and has averted that thanks to bold actions," Hecht said. "But there's no room for complacency. This is the moment for Cambodia to strike a bargain with its outside funders such as the Global Fund, Australia, and the U.S. If these funders maintain a modest level of financial support to help preserve Cambodia's gains to date, the government can gradually step in to assume fuller and more sustainable funding of its AIDS program."



H.E. Dr. Mean Chhi Vun, Director of the National Centre for HIV/AIDS, Dermatology and STD, said that the report comes at an important time for the Cambodian government as it begins to assume more of the cost of AIDS programs from donors. "This report will play a key role in our discussions on how to move forward," Dr. Vun said. "We are committed to finding the most cost-efficient solutions as well as the most effective programs. We will draw upon our own experiences over the last decade and more, but we will also use these important findings to help guide us."



The report examines the costs in fighting Cambodia's epidemic under various strategies, ranging from US$ 1.4 billion during 2009 to 2031 under the current plan, to US$2.3 billion over the 22-year period in a dramatically stepped-up prevention plan - a differential of $900 million, or nearly 40 percent. The report's authors recommend a third course that stops nearly as many new infections as the most expensive approach, but costs much less because it emphasizes spending selectively on the highest impact prevention services, such as promoting consistent condom use in high risk settings.



"Cambodia has many choices in front of it," said Dr. Vonthanak Saphonn, the lead Cambodian author of the report and Deputy Director of the National Institute of Public Health. "Our recommendation is that Cambodia needs to focus investments on HIV/AIDS in those areas that are most cost-effective. This may mean that the country has to evaluate each intervention and focus on those that are contributing the most to the national program in a cost-effective manner."



Richard Skolnik, a professor of public health at George Washington University and the lead technical adviser to R4D on the project, said he believes the country's past history of success in fighting AIDS bodes well for the future. But he said difficult financial decisions will have to be made now.



"We have every reason to believe Cambodia can continue its effective fight against the epidemic," Skolnik said. "But Cambodia is very dependent on its external partners on financing, and if they don't put enough government money into the program and focus on the wisest investments, even this outstanding program could be threatened."



Tony Lisle, UNAIDS Country Coordinator for Cambodia, welcomed the report and said he hoped it would make a strong contribution to the country's ongoing fight against AIDS. "I hope this provides an opportunity for Cambodian officials to intensify their already strong efforts against AIDS with the kind of vigor it has shown in the past," Lisle said. "Cambodia has been a shining example around the world when it comes to lowering HIV infections, and I believe it can now make further adjustments that will allow it to remain a leader."



Source:

Denise Young


Burness Communications

WFP To Feed 200,000 Vulnerable People Affected By Food Emergency In Tajikistan

The United Nations World Food Programme said it was
appealing for an extra US$8.3 million to help feed hundreds of thousands
of people in Tajikistan suffering from food shortages amid soaring food
and fuel prices, in the coldest winter the country has seen for three
decades and an unprecedented energy crisis.



The UN food agency's request is part of a wider UN joint appeal for
US$25 million to help Tajikistan cope with a harsh cold spell that has
prompted the government to ration electricity, water and gas supplies in
a country where nearly two thirds of the population are classified as
poor.



WFP said it would use the funds to purchase and distribute three months
worth of emergency food rations for 200,000 of the most vulnerable
people, the majority of whom live in rural areas. WFP's NGO partners
will assist an additional 60,000 of the affected people.



Tajikistan's millions have been forced to spend more of what little
money they have on fuel to keep warm in temperatures that have dropped
to as low as -25°C. With high food prices - linked to rising global
prices - more and more people are unable to buy enough food to sustain
themselves and their families.



"People are spending substantially more on food then before and eating
less, much less. We already see many poor families forced to eat just
one meal a day. Many have already sold their animals and other
productive assets," said WFP Tajikistan Country Director Zlatan Milisic.



"About 10 percent of the rural population, or 500,000 people, are
chronically food insecure and a further 17 percent are very vulnerable
to food insecurity," Milisic said. "This is the last thing they needed."



WFP already has a two-year operation in Tajikistan - which started in
July 2007 - to assist 591,000 people with 37,700 metric tons of food at
an overall cost of US$23 million and is already providing regular basic
food assistance to around 300,000 to 400,000 persons in 40 districts of
Tajikistan.



The operation encourages children to enrol and attend school, supports
malnourished children, pregnant and lactating women and tuberculosis
patents and helps communities rehabilitate their assets. It also
provides emergency aid to victims of natural disasters, such as
earthquakes, landslides, mud flows and floods.



Some food from the ongoing operation has already being transferred or
loaned for the emergency response. WFP is currently preparing a dispatch
of some 1,850 metric tons of food for around 105,000 of the most
critically affected people. "As soon as we receive confirmations of new
funding, we will be able to advance further emergency relief to the
people in need, from the existing stocks," Milisic said.



So far, WFP has received US$2.2 million from the UN Central Emergency
Revolving Fund (CERF). Italy has contributed a further US$216,000,
leaving a shortfall of just below US$5.9 million.



WFP is the world's largest humanitarian agency: in 2008. we plan to
provide food to more than 70 million people - mostly women and children
- in around 80 of the world's poorest countries.

wfp

Final Senate Passage Of 108 Million Dollars To Expand Health Coverage For 9/11 Emergency Responders And Others

Senators Frank Lautenberg, Robert Menendez Hillary Rodham Clinton and Charles Schumer announced final Senate passage of an additional 108 million dollars in federal funding to address the mounting health needs of those individuals who were exposed to environmental hazards released as a result of the September 11, 2001 attacks upon the World Trade Center. The money builds on the $50 million that was provided in the Emergency Supplemental Appropriations Bill that was signed into law earlier this year, bringing total funding for the year to $158 million.


The latest funding increase was approved as part of the Fiscal Year 2008 Omnibus Appropriations Bill and includes $51.5 million in the Fiscal Year 2008 Labor, Health and Human Services (HHS) Appropriations Bill and $56.5 million in additional emergency spending. The omnibus bill, which includes 11 appropriations bills, will now go back to the House for final passage before being sent to the President for signature.


"First responders, emergency workers and volunteers showed true courage during the recovery effort after the 9/11 terrorist attacks. Now, many of these brave men and women are suffering serious illnesses from the toxins at Ground Zero. I look forward to the House passing this bill and the President signing it into law so these heroes can get the treatment they deserve," said Senator Lautenberg.


Senator Menendez said, "This is the type of federal commitment that puts the mantra 'We will never forget' into action, and it's the type of commitment that had been lacking in previous Congresses. With major investments in the health of those who inhaled the toxic air around Ground Zero, we can help address the needs of all those who deserve their government's attention and resources, whether they developed symptoms in the days after 9/11 or in the years after 9/11. Moving forward, we cannot rest until all of those who inhaled the toxic dust around Ground Zero are examined and those found to be sick are treated."


"Six years after the tragedy of September 11, 2001, that day's tragic events continue to afflict many of those who lived and worked near Ground Zero, as well as those brave responders who rushed to the scene," said Senator Clinton. "By approving this important funding, we are recommitting to stand with the victims of September 11th for as long as it takes."


"It is high time that the first responders and residents of Lower Manhattan that were exposed to toxins six years ago receive the treatment they need and deserve. I am pleased that the Senate approved this essential funding for the men and women who are now suffering from the effects of the attacks, and promise to continue to fight for the full funding they need," Senator Schumer said.



The $108 million in new funding will go towards monitoring and treatment activities administered by the National Institute for Occupational Safety and Health (NIOSH) to help those individuals who were exposed to the environmental hazards released on and after 9/11. The $51.5 million portion in the Fiscal Year 2008 Labor, Health and Human Services (HHS) Appropriations Bill also includes statutory language requiring the Department of Health and Human Services, through NIOSH, to expand the program beyond responders and rescue workers to entities that would provide services to residents, office and commercial workers, students, and other individuals who were exposed. Existing programs to serve those who were impacted include the centers in the Mount Sinai Consortium and the program run by the New York City Fire Department.


The lawmakers said that the approved funding is a recognition of the importance of addressing the short and long-term health needs of those individuals who were exposed to the environmental hazards released as a result of the September 11, 2001 attacks upon the World Trade Center, and affirms the commitment of the federal government to provide assistance to those whose physical and mental health was adversely impacted as a result of this exposure. More than six years after the attacks, persistent health effects have been documented among rescue and recovery workers, such as asthma, chronic sinusitis, and gastrointestinal conditions. Post-traumatic stress disorder (PTSD), anxiety, depression, and other health effects have also been diagnosed among those who have been exposed.

lautenberg.senate/

How Best Can We Train Health Workers To Deliver HIV Care In Poor Countries?

In order to deliver HIV medicines to patients in poor countries, local health workers need to be trained, and yet few countries have a comprehensive training plan, say Elizabeth McCarthy and colleagues from the Clinton Foundation HIV/AIDS Initiative.



The authors examine challenges and approaches to training health care workers in low income countries on how to provide HIV care. They also suggest the kinds of research that will be needed to define the best approach to such training.







PLEASE MENTION THE OPEN-ACCESS JOURNAL PLoS MEDICINE (plosmedicine/) AS THE SOURCE FOR THESE ARTICLES AND PROVIDE A LINK TO THE FREELY-AVAILABLE TEXT. THANK YOU.



All works published in PLoS Medicine are open access. Everything is immediately available without cost to anyone, anywhere--to read, download, redistribute, include in databases, and otherwise use--subject only to the condition that the original authorship is properly attributed. Copyright is retained by the authors. The Public Library of Science uses the Creative Commons Attribution License.



Citation: McCarthy EA, O'Brien ME, Rodriguez WR (2006) Training and HIV-treatment scale-up: Establishing an implementation research agenda. PLoS Med 3(7): e304.



PLEASE ADD THE LINK TO THE PUBLISHED ARTICLE IN ONLINE VERSIONS OF YOUR REPORT: dx.doi/10.1371/journal.pmed.0030304



CONTACT:


Elizabeth McCarthy

Clinton Foundation HIV/AIDS Initiative

Consortium for Strategic HIV Operations Research

225 Water Street

Quincy, MA 02169 United States of America


emccarthyclintonfoundation



About PLoS Medicine

PLoS Medicine is an open access, freely available international medical journal. It publishes original research that enhances our understanding of human health and disease, together with commentary and analysis of important global health issues. For more information, visit plosmedicine/



Contact: Andrew Hyde


Public Library of Science